Provider Demographics
NPI:1912491234
Name:GRANTHAM, SABRINA (PA-C)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4550 NORTH BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4013
Mailing Address - Country:US
Mailing Address - Phone:225-665-6422
Mailing Address - Fax:225-341-5903
Practice Address - Street 1:3801 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3825
Practice Address - Country:US
Practice Address - Phone:225-665-6422
Practice Address - Fax:225-341-5903
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309573363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical