Provider Demographics
NPI:1811393655
Name:GRANT, LORI (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3619
Mailing Address - Country:US
Mailing Address - Phone:928-757-2101
Mailing Address - Fax:
Practice Address - Street 1:14355 MIRANDA WAY
Practice Address - Street 2:
Practice Address - City:LOS ALTOS HILLS
Practice Address - State:CA
Practice Address - Zip Code:94022-2032
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056976363LW0102X
VA0024182593363LW0102X
KS53-81208-051363LW0102X
WAAP61304805363LW0102X
MN9340363LW0102X
NE114069363LW0102X
MT192748363LW0102X
COC-APN.0002691-C-NP363LW0102X
CA95026674363LW0102X
WI13428-33363LW0102X
SDCP002700363LW0102X
MI4704395700363LW0102X
AK196726363LW0102X
HI3708-0363LW0102X
AZAP7447363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health