Provider Demographics
NPI:1720404650
Name:GRANT, IRENE N (LPN)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:N
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4225
Mailing Address - Country:US
Mailing Address - Phone:864-882-2245
Mailing Address - Fax:864-885-5965
Practice Address - Street 1:609 N TOWNVILLE ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2642
Practice Address - Country:US
Practice Address - Phone:864-882-2245
Practice Address - Fax:864-885-9659
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26333P164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse