Provider Demographics
NPI:1710638796
Name:GRANT, MARIA (RN , IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN , IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 LIDO BLVD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-713-1147
Mailing Address - Fax:516-432-7892
Practice Address - Street 1:523 LIDO BLVD
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-5238
Practice Address - Country:US
Practice Address - Phone:516-713-1147
Practice Address - Fax:516-432-7892
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-152931163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant