Basic Information
| Provider Information | |||||||||
| NPI: | 1568798007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANTHAM | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | HEATH ANDERSON | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751649 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437891620 | ||||||||
| FaxNumber: | 8437242440 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 HIGHWAY 17 N | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294668227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436068960 | ||||||||
| FaxNumber: | 8436068961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2009 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 363LF0000X | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.