Provider Demographics
NPI:1346256294
Name:GRANT, JANELL (APRN-C)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2227
Mailing Address - Country:US
Mailing Address - Phone:308-761-1151
Mailing Address - Fax:308-761-1139
Practice Address - Street 1:203 E 3RD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301
Practice Address - Country:US
Practice Address - Phone:308-761-1151
Practice Address - Fax:308-761-1139
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP48843Medicare UPIN
NE275095Medicare ID - Type Unspecified