Provider Demographics
NPI:1346843281
Name:GRANT, LORAINE IUNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LORAINE IUNE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 FABLED WATERS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3469
Mailing Address - Country:US
Mailing Address - Phone:619-770-8901
Mailing Address - Fax:
Practice Address - Street 1:1889 FABLED WATERS DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3469
Practice Address - Country:US
Practice Address - Phone:619-770-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013848207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95043423OtherBOARD OF REGISTERED NURSING