Provider Demographics
NPI:1306817671
Name:GRAINGER, SUSAN HUGGINS (PNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HUGGINS
Last Name:GRAINGER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 BROAD ST
Practice Address - Street 2:DBA FORSYTH PEDIATRIC ASSOC. - K'VILLE
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2930
Practice Address - Country:US
Practice Address - Phone:336-993-8333
Practice Address - Fax:336-993-5144
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC086287363L00000X
NC300252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005439Medicaid