Provider Demographics
NPI:1881979532
Name:GRANT, KAREN (MEDICAL ASSISTANT/CE)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT/CE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 SOUTH WALTER REED DRIVE
Mailing Address - Street 2:SUITE 462A
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204
Mailing Address - Country:US
Mailing Address - Phone:571-236-4360
Mailing Address - Fax:571-236-4360
Practice Address - Street 1:627 SOUTH WALTER REED DRIVE
Practice Address - Street 2:SUITE 462A
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:571-236-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00604623310400000X, 376K00000X
VA1401133273310400000X
VA255863310400000X
VA1401133272376K00000X
DC255863376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility