Provider Demographics
NPI:1275908204
Name:GRANT, ERIKA (MS RD LD CNSC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS RD LD CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GOOSE ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-5246
Mailing Address - Country:US
Mailing Address - Phone:802-309-9094
Mailing Address - Fax:
Practice Address - Street 1:181 GOOSE ROCKS RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNKPORT
Practice Address - State:ME
Practice Address - Zip Code:04046-5246
Practice Address - Country:US
Practice Address - Phone:802-309-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered