Provider Demographics
NPI:1437256153
Name:GRANT, PAMELA K (MSN, RN, CPNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 N. 32ND DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3998
Mailing Address - Country:US
Mailing Address - Phone:602-866-1974
Mailing Address - Fax:602-375-3949
Practice Address - Street 1:15420 N. 32ND DRIVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3998
Practice Address - Country:US
Practice Address - Phone:602-866-1974
Practice Address - Fax:602-375-3949
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1990363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ963670Medicaid