Provider Demographics
NPI:1215635719
Name:GRANT, CHANTEL DOBB (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:DOBB
Last Name:GRANT
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5695 GRAND RIVER DR NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8662
Mailing Address - Country:US
Mailing Address - Phone:616-308-2473
Mailing Address - Fax:
Practice Address - Street 1:5695 GRAND RIVER DR NE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8662
Practice Address - Country:US
Practice Address - Phone:616-308-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232925163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy