Basic Information
| Provider Information | |||||||||
| NPI: | 1801899349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANTHAM | ||||||||
| FirstName: | DANIELLA | ||||||||
| MiddleName: | DEONA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 SOLAR WAY | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762072204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403910235 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7121 S PADRE ISLAND DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784124940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619936000 | ||||||||
| FaxNumber: | 3619933676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2005 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 559826 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | AP108955 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 120095808 | 05 | TX | MEDICAID |