Provider Demographics
NPI:1841709045
Name:GRANDSTAFF, NELTIE CURTIS IV (RN)
Entity type:Individual
Prefix:MR
First Name:NELTIE
Middle Name:CURTIS
Last Name:GRANDSTAFF
Suffix:IV
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 E HOXIE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-9414
Mailing Address - Country:US
Mailing Address - Phone:231-645-0712
Mailing Address - Fax:
Practice Address - Street 1:7135 E HOXIE RD
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621
Practice Address - Country:US
Practice Address - Phone:231-645-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241635163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse