Basic Information
| Provider Information | |||||||||
| NPI: | 1003462235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | GENEVIEVE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 639561 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452639561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478073917 | ||||||||
| FaxNumber: | 8473483706 | ||||||||
| Practice Location | |||||||||
| Address1: | 2460 W 26TH AVE STE 217 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802115308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033227108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2019 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | N | Nursing Service Related Providers | Nurse's Aide | 106S00000X | RBT-20-137743 | CO | Y |
No ID Information.