Provider Demographics
NPI:1134977200
Name:GRANT, RAMELL J (RN)
Entity type:Individual
Prefix:
First Name:RAMELL
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 CROWN RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2869
Mailing Address - Country:US
Mailing Address - Phone:214-912-6948
Mailing Address - Fax:
Practice Address - Street 1:4414 CROWN RUN RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2869
Practice Address - Country:US
Practice Address - Phone:214-912-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX730879163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator