Individual
JACEY LYNN GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204-4597
(303) 436-6000
Mailing address
777 BANNOCK ST, DENVER, CO 80204-4507
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
MA055863
PA
363AS0400X
Surgical Physician Assistant
Primary
PA0007976
CO
Other
Enumeration date
11/06/2012
Last updated
07/20/2023
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