Provider Demographics
NPI:1518954478
Name:GRANT, LORI HEPPARD (DNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:HEPPARD
Last Name:GRANT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:HEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 MALLARD ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4046
Mailing Address - Country:US
Mailing Address - Phone:864-241-1040
Mailing Address - Fax:
Practice Address - Street 1:2710 GLASGOW AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4736
Practice Address - Country:US
Practice Address - Phone:302-834-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000116363L00000X
SC22041363L00000X
DELG0000330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13418Medicare UPIN
MD406134300Medicaid
DE000117342Medicaid
MD036MI443Medicare PIN
NJ0046981Medicaid
DE014005N74Medicare PIN