Provider Demographics
NPI:1578937041
Name:GRANT, REBECCA LYNN (ADN RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:GRANT
Suffix:
Gender:F
Credentials:ADN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26778 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TURIN
Mailing Address - State:IA
Mailing Address - Zip Code:51040-8720
Mailing Address - Country:US
Mailing Address - Phone:712-420-5222
Mailing Address - Fax:712-353-6646
Practice Address - Street 1:26778 OAK AVE
Practice Address - Street 2:
Practice Address - City:TURIN
Practice Address - State:IA
Practice Address - Zip Code:51040-8720
Practice Address - Country:US
Practice Address - Phone:712-420-5222
Practice Address - Fax:712-353-6646
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091552163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse