Provider Demographics
NPI:1881201242
Name:GRANT, BRANDY YVONNE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:YVONNE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LEVRON ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5573
Mailing Address - Country:US
Mailing Address - Phone:985-228-2531
Mailing Address - Fax:
Practice Address - Street 1:320 PROGRESSIVE BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4069
Practice Address - Country:US
Practice Address - Phone:985-303-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant