Basic Information
| Provider Information | |||||||||
| NPI: | 1629318464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | ALEXANDREA | ||||||||
| MiddleName: | KERRY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2850 W 24TH ST APT 15G | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112242353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183730116 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1285 ROCKAWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112362330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182573195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2013 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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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 | 163WP0808X | 655262-1 | NY | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.