Provider Demographics
NPI:1245052380
Name:GRANT, VEVLYN
Entity type:Individual
Prefix:
First Name:VEVLYN
Middle Name:
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 1:855 E TWAIN AVE
Mailing Address - Street 2:SUITE 123, #444
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169
Mailing Address - Country:US
Mailing Address - Phone:954-867-4654
Mailing Address - Fax:
Practice Address - Street 1:1600 QUEEN VICTORIA ST UNIT 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6886
Practice Address - Country:US
Practice Address - Phone:702-763-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker