Provider Demographics
NPI:1700892817
Name:GRANT, CATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 EMILIO CENTER SUITE 3
Mailing Address - Street 2:
Mailing Address - City:SLICKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15684
Mailing Address - Country:US
Mailing Address - Phone:724-468-4099
Mailing Address - Fax:724-468-3370
Practice Address - Street 1:3021 EMILIO CENTER
Practice Address - Street 2:SUITE 3
Practice Address - City:SLICKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15684
Practice Address - Country:US
Practice Address - Phone:724-468-4099
Practice Address - Fax:724-468-3370
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001497-B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA83048Medicaid
PAS35961Medicare UPIN