Provider Demographics
NPI:1710418025
Name:GRANT, SILVIA RAQUEL (NP)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:RAQUEL
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SILVIA
Other - Middle Name:RAQUEL
Other - Last Name:NAVARRETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:62491 OWSLEY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5175
Mailing Address - Country:US
Mailing Address - Phone:305-316-9214
Mailing Address - Fax:
Practice Address - Street 1:62491 OWSLEY CANYON RD
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-5175
Practice Address - Country:US
Practice Address - Phone:305-316-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9342846363LP2300X
AZAP10073363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care