Provider Demographics
NPI:1902007198
Name:GRANT, NICOLE NILMEIER (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NILMEIER
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 HILLANDALE RD
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2650
Mailing Address - Country:US
Mailing Address - Phone:919-383-6107
Mailing Address - Fax:919-383-6128
Practice Address - Street 1:1824 HILLANDALE RD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2650
Practice Address - Country:US
Practice Address - Phone:919-383-6107
Practice Address - Fax:919-383-6128
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI26214Medicare UPIN