Provider Demographics
NPI:1578808770
Name:GRANT-SINGH, ALICIA LAURELL (FNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LAURELL
Last Name:GRANT-SINGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LAURELL
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:7 MAIN RD N
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1334
Practice Address - Country:US
Practice Address - Phone:207-862-9400
Practice Address - Fax:207-862-9411
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOTH00Medicare PIN