Provider Demographics
NPI:1962455287
Name:MCNALL, GRANT M (RN)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:M
Last Name:MCNALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-1783
Mailing Address - Country:US
Mailing Address - Phone:608-754-0340
Mailing Address - Fax:
Practice Address - Street 1:619 MONROE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1783
Practice Address - Country:US
Practice Address - Phone:608-754-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138786-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse