Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP137222 | TX |
NPI | 1336645787 |
---|---|
Provider Name | Adela Annette Grant |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
385106501 | (05) | TX |
385106502 | CSHCN (01) | TX |