Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A121328 | CA |
N | 208600000X | Surgeon | A121328 | CA |
N | 208200000X | Surgeon | TBD | DC |
N | 208600000X | Surgeon | TBD | DC |
Y | 2086S0120X | Pediatric Surgery | 314041-01 | NY |
NPI | 1598990467 |
---|---|
Provider Name | Christa Nicole Grant |
First Address | Ann Arbor, MI 48109-4211 |
Second Address | Valhalla, NY 10595-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2009 |
Last Update Date | 07/02/2022 |