Provider Demographics
NPI:1326699760
Name:GRANT, ELIZABETH ANN (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1218 VT ROUTE 17 E
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:VT
Mailing Address - Zip Code:05491-8621
Mailing Address - Country:US
Mailing Address - Phone:802-759-2067
Mailing Address - Fax:
Practice Address - Street 1:1218 RTE 17E
Practice Address - Street 2:ENTER YOUR MAILING ADDRES
Practice Address - City:ADDISON
Practice Address - State:VT
Practice Address - Zip Code:05491
Practice Address - Country:US
Practice Address - Phone:802-922-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0016175163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice