Provider Demographics
NPI:1508934332
Name:GRANT, ELIZABETH C (LIC AC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:GRANT
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1880
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-1880
Mailing Address - Country:US
Mailing Address - Phone:508-349-7700
Mailing Address - Fax:
Practice Address - Street 1:LAUGHING HEARTS
Practice Address - Street 2:285A BANK STREET
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667
Practice Address - Country:US
Practice Address - Phone:508-349-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist