Provider Demographics
NPI:1568959500
Name:GRANT, DEBRA WHITE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:WHITE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 VEST MILL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2989
Mailing Address - Country:US
Mailing Address - Phone:336-765-2273
Mailing Address - Fax:
Practice Address - Street 1:3560 VEST MILL RD STE 7
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2989
Practice Address - Country:US
Practice Address - Phone:336-765-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1254374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide