Provider Demographics
NPI:1760030027
Name:GRANDERSON, PHEBE JOY (CNM)
Entity Type:Individual
Prefix:
First Name:PHEBE
Middle Name:JOY
Last Name:GRANDERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:PHEBE
Other - Middle Name:JOY
Other - Last Name:GRANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 S 1ST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4504
Mailing Address - Country:US
Mailing Address - Phone:479-935-3392
Mailing Address - Fax:866-441-1301
Practice Address - Street 1:214 S 1ST ST STE 203
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4504
Practice Address - Country:US
Practice Address - Phone:479-935-3392
Practice Address - Fax:866-441-1301
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM002138367A00000X
OKM115216367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife