Provider Demographics
NPI:1154694065
Name:GRANT, JEANETTE M (DNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:MISSOURI
Other - Last Name:SESSOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:100 RAWLINS DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-5881
Mailing Address - Country:US
Mailing Address - Phone:302-990-3300
Mailing Address - Fax:302-990-3300
Practice Address - Street 1:21444 CARMEAN WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4572
Practice Address - Country:US
Practice Address - Phone:302-855-1233
Practice Address - Fax:302-855-2025
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169918363LF0000X
DELG-0012313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154694065Medicaid
VAP01038878Medicare PIN
VA1154694065Medicaid