Provider Demographics
NPI:1245505882
Name:GRANT, GEORGIA LOUISE (NP)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:LOUISE
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6900 EAST 47TH AVENUE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3449
Mailing Address - Country:US
Mailing Address - Phone:303-333-4411
Mailing Address - Fax:303-333-8719
Practice Address - Street 1:6900 EAST 47TH AVENUE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3449
Practice Address - Country:US
Practice Address - Phone:303-333-4411
Practice Address - Fax:303-333-8719
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO27726363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27726OtherLICENSE