Provider Demographics
NPI:1376836650
Name:GRANT, CECILIA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANN
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-1405
Mailing Address - Country:US
Mailing Address - Phone:414-449-5367
Mailing Address - Fax:414-449-5367
Practice Address - Street 1:3920 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1405
Practice Address - Country:US
Practice Address - Phone:414-449-5367
Practice Address - Fax:414-449-5367
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309664031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse