Provider Demographics
NPI:1376187385
Name:GRANTHAM, JEANEFER (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEANEFER
Middle Name:
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 HAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-5214
Mailing Address - Country:US
Mailing Address - Phone:276-730-5952
Mailing Address - Fax:
Practice Address - Street 1:7515 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:HOLLINS
Practice Address - State:VA
Practice Address - Zip Code:24019-4301
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily