Individual
MRS. MARILOU GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
314 OAK ST, OLD FORGE, PA 18518-1619
(570) 457-7150
(570) 457-8611
Mailing address
518 HILL ST, DURYEA, PA 18642-1619
(570) 457-0218
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
UP004462B
PA
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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