| Doctor Name: | MS. CAROLE GRANT |
| NPI Number: | 1609176882 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD,LD,CNSC |
| License Number: | LD003592 |
| Business Practice Address: | 200 West Hospital Drive Whiteriver, AZ - 85941 |
| Business Phone Number: | 9283383647 |
| Business Fax Number: | |
| Mailing Address: | 1081 E Cedar Ridge Run, SHOW LOW |
| State: | AZ |
| Postal Code: | 859017308 |
| Phone Number: | 9283383647 |
| Fax Number: | 9283383522 |
| NPI Enumeration Date: | 10/22/2010 |
| NPI Last Update Date: | 03/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | LD003592 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |