Provider Demographics
NPI:1649719410
Name:GRANT, CRYSTAL (RN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
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 1:204 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-9355
Mailing Address - Country:US
Mailing Address - Phone:843-326-5347
Mailing Address - Fax:843-326-1086
Practice Address - Street 1:204 E PEARL ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069-9355
Practice Address - Country:US
Practice Address - Phone:843-326-5347
Practice Address - Fax:843-326-1086
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC211504163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool