Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00419200 | NJ |
NPI | 1003158502 |
---|---|
Provider Name | Grant Marshall Myers |
First Address | Old Saybrook, CT 06475-4214 |
Second Address | Ewing, NJ 08628-1020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 29/04/2013 |