Doctor Name: | STACIE GRANT |
NPI Number: | 1013054485 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 420749 |
Business Practice Address: | 38 Heritage Ct Lockport, NY - 140943616 |
Business Phone Number: | 7164334465 |
Business Fax Number: | |
Mailing Address: | 100 Parkridge Ave, BUFFALO |
State: | NY |
Postal Code: | 142152210 |
Phone Number: | 7164334465 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 03/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 420749 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |