Provider Demographics
NPI:1831741503
Name:GRANT, BLAIR ALEXANDRIA (MSN, APRN-RX, FNP-BC)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:ALEXANDRIA
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSN, APRN-RX, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3030
Mailing Address - Country:US
Mailing Address - Phone:808-391-7776
Mailing Address - Fax:
Practice Address - Street 1:2547 10TH AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3030
Practice Address - Country:US
Practice Address - Phone:808-391-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-74495163W00000X
HI2833363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner