Provider Demographics
NPI:1215085352
Name:GRANT, LAMONT BERLLINDA (RN)
Entity type:Individual
Prefix:MRS
First Name:LAMONT
Middle Name:BERLLINDA
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-5104
Mailing Address - Country:US
Mailing Address - Phone:877-493-0974
Mailing Address - Fax:877-493-0974
Practice Address - Street 1:22234 E PINEY GROVE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-7800
Practice Address - Country:US
Practice Address - Phone:877-493-0974
Practice Address - Fax:877-493-0974
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELL-0034062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse