Provider Demographics
NPI:1538155734
Name:GRANT, ELIZA EVA M (CNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZA
Middle Name:EVA M
Last Name:GRANT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-680-3666
Mailing Address - Fax:847-680-3994
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-680-3666
Practice Address - Fax:847-680-3994
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL309000225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily