Provider Demographics
NPI:1457475170
Name:GRANT, WINSOME LEONIE (PHD, NP)
Entity Type:Individual
Prefix:DR
First Name:WINSOME
Middle Name:LEONIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:50 COLUMBUS AVE
Mailing Address - Street 2:TOWNHOUSE C 10
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2527
Mailing Address - Country:US
Mailing Address - Phone:914-961-3738
Mailing Address - Fax:
Practice Address - Street 1:163 W 125TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4436
Practice Address - Country:US
Practice Address - Phone:212-531-8011
Practice Address - Fax:212-749-1375
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY330629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ17210Medicare UPIN