Provider Demographics
NPI:1972300895
Name:GRANT, MADELINE BETH (FNP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:BETH
Last Name:GRANT
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 GARDEN PASSAGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-9708
Mailing Address - Country:US
Mailing Address - Phone:703-987-5323
Mailing Address - Fax:
Practice Address - Street 1:1616 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4968
Practice Address - Country:US
Practice Address - Phone:984-217-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily