Provider Demographics
NPI:1518124445
Name:GRANT-NIERMAN, MEGGAN JUSTINE (DO)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:JUSTINE
Last Name:GRANT-NIERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGGAN
Other - Middle Name:JUSTINE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:910 RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9665
Mailing Address - Country:US
Mailing Address - Phone:719-539-6637
Mailing Address - Fax:
Practice Address - Street 1:910 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9665
Practice Address - Country:US
Practice Address - Phone:719-539-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6951207Q00000X
CO51137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine