Provider Demographics
NPI:1649783168
Name:GRANT, AMY B (LIC AC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:GRANT
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2712
Mailing Address - Country:US
Mailing Address - Phone:207-712-3981
Mailing Address - Fax:
Practice Address - Street 1:254 N STATE ST UNIT E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3224
Practice Address - Country:US
Practice Address - Phone:603-369-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist