Provider Demographics
NPI:1245653831
Name:GRANT, DIANE (RN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 DANDELION LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-6761
Mailing Address - Country:US
Mailing Address - Phone:972-955-2122
Mailing Address - Fax:972-412-5946
Practice Address - Street 1:2513 DANDELION LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-6761
Practice Address - Country:US
Practice Address - Phone:972-955-2122
Practice Address - Fax:972-412-5946
Is Sole Proprietor?:No
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720743163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse