Provider Demographics
NPI:1669809208
Name:GRANT, JANE M (RD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WEBSTER SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2326
Mailing Address - Country:US
Mailing Address - Phone:860-357-2282
Mailing Address - Fax:
Practice Address - Street 1:37 WEBSTER SQUARE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2326
Practice Address - Country:US
Practice Address - Phone:860-357-2282
Practice Address - Fax:860-357-2555
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered