Basic Information
| Provider Information | |||||||||
| NPI: | 1124269998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT-ELLIS | ||||||||
| FirstName: | CARON | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3691 W YELLOW PEAK DR | ||||||||
| Address2: | |||||||||
| City: | QUEEN CREEK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852423076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806774160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 554 S BELLVIEW | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852042504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806491141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2009 | ||||||||
| LastUpdateDate: | 03/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA0400X | RN133597 | AZ | Y | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No ID Information.