Provider Demographics
NPI:1811611890
Name:GRAINGER, MANDY (RN)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:GRAINGER
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 1:11817 CANON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4516
Mailing Address - Country:US
Mailing Address - Phone:757-595-8005
Mailing Address - Fax:757-595-9131
Practice Address - Street 1:11817 CANON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4516
Practice Address - Country:US
Practice Address - Phone:757-595-8005
Practice Address - Fax:757-595-9131
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001267550163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health