Provider Demographics
NPI:1902423189
Name:GRANTHAM, SARAH CASSIDY (R, IBCLC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CASSIDY
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:R, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CARRIE CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-7038
Mailing Address - Country:US
Mailing Address - Phone:252-665-0813
Mailing Address - Fax:
Practice Address - Street 1:307 CARRIE CT
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7038
Practice Address - Country:US
Practice Address - Phone:252-665-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253238163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant