Provider Demographics
NPI:1487401667
Name:GRANT, JOAN (RN, BSN, CCM)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 HIGHWAY 287 N # 1102
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4807
Mailing Address - Country:US
Mailing Address - Phone:940-536-3430
Mailing Address - Fax:
Practice Address - Street 1:1781 HIGHWAY 287 N # 1102
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4807
Practice Address - Country:US
Practice Address - Phone:940-536-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty