Provider Demographics
NPI:1578846945
Name:GRANT, JULIE M
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:M
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 1:66 HOOPER ST
Mailing Address - Street 2:BURNELL HALL ROOM 113
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02325-0001
Mailing Address - Country:US
Mailing Address - Phone:508-531-1823
Mailing Address - Fax:
Practice Address - Street 1:66 HOOPER ST
Practice Address - Street 2:BURNELL HALL ROOM 113
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02325-0001
Practice Address - Country:US
Practice Address - Phone:508-531-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program