Provider Demographics
NPI:1336035120
Name:GRANT, GEVAEH A
Entity type:Individual
Prefix:
First Name:GEVAEH
Middle Name:A
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W RAYEN AVE APT 106C
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1164
Mailing Address - Country:US
Mailing Address - Phone:330-978-2555
Mailing Address - Fax:
Practice Address - Street 1:348 W RAYEN AVE APT 106C
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1164
Practice Address - Country:US
Practice Address - Phone:330-978-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVE965354374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide