Provider Demographics
NPI:1912694597
Name:GRANT, NIA (CSCS, CPT, CES, RD)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:CSCS, CPT, CES, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4472 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-1035
Practice Address - Country:US
Practice Address - Phone:201-245-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No374J00000XNursing Service Related ProvidersDoula