Individual
ALEXA NOELLE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 842-2828
Mailing address
435 W COOK ST, MANTENO, IL 60950-1660
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209033540
IL
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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