Provider Demographics
NPI:1144679366
Name:OVID-GRANT, CHARLENE
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:OVID-GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:OVID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22044 CLARENDON STREET
Mailing Address - Street 2:APT.328
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:818-384-5940
Mailing Address - Fax:
Practice Address - Street 1:16360 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1219
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN139459164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse