Provider Demographics
NPI:1013459981
Name:GRANDY, SCARLETT VANESSA (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:VANESSA
Last Name:GRANDY
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:FORAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP-BC
Mailing Address - Street 1:1513 S GRAND AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3075
Mailing Address - Country:US
Mailing Address - Phone:213-747-5542
Mailing Address - Fax:
Practice Address - Street 1:1513 S GRAND AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3075
Practice Address - Country:US
Practice Address - Phone:213-747-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005220363LW0102X
CA235818367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health