Provider Demographics
NPI:1053313460
Name:GRANT, LOUISE P (PHD, RD, LD/N)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:P
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1624
Mailing Address - Country:US
Mailing Address - Phone:305-575-3251
Mailing Address - Fax:305-575-7022
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3251
Practice Address - Fax:305-575-7022
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered