| NPI | 1104254788 |
|---|---|
| Former Name | KELLY MARIE GRANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71014734A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209010641) |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2023-12-13 |