Provider Demographics
NPI:1043216880
Name:GRANT, LINDA J (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 E VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2034
Mailing Address - Country:US
Mailing Address - Phone:610-428-1544
Mailing Address - Fax:610-395-9336
Practice Address - Street 1:15 OBOLD RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8214
Practice Address - Country:US
Practice Address - Phone:610-488-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN176532L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012410200001Medicaid
PA1012410200001Medicaid