Provider Demographics
NPI:1477334019
Name:GRANT, DECHANEL (PWC)
Entity Type:Individual
Prefix:
First Name:DECHANEL
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:PWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 NE 10TH ST STE B101
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3653
Mailing Address - Country:US
Mailing Address - Phone:405-352-2522
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST STE B101
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3653
Practice Address - Country:US
Practice Address - Phone:405-352-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171400000X, 172V00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker