Provider Demographics
NPI:1912140641
Name:VANMETER, GRANT E (CRNA)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:E
Last Name:VANMETER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2178
Mailing Address - Country:US
Mailing Address - Phone:361-573-6291
Mailing Address - Fax:361-576-2434
Practice Address - Street 1:1501 E MOCKINGBIRD LN
Practice Address - Street 2:#220
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-573-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875993367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX413780YL87OtherMEDICARE PTAN