Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024183550 | VA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AC004122 | MD |
NPI | 1003568551 |
---|---|
Provider Name | Mrs. Erica Granteed |
First Address | Hillsboro, VA 20132-2569 |
Second Address | North Bethesda, MD 20852-4933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2022 |
Last Update Date | 03/02/2022 |