NPI | 1467430454 |
---|---|
Former Name | ANN RENEE GRANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-28153) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-04606) |
207Q00000X Family Medicine (Licence: OK 244) | |
207Q00000X Family Medicine (Licence: NM A-1847-14) | |
Enumeration Date | 2006-01-09 |
Last Update Date | 2023-03-07 |