Provider Demographics
NPI:1770606527
Name:GRANT, JUDITH L (ANP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:L
Last Name:GRANT
Suffix:
Gender:F
Credentials:ANP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10 LOWER CAMPUS DR
Mailing Address - Street 2:ALFRED STATE COLLEGE HEALTH SERVICES
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1196
Mailing Address - Country:US
Mailing Address - Phone:607-587-4200
Mailing Address - Fax:607-587-4203
Practice Address - Street 1:10 LOWER CAMPUS DR
Practice Address - Street 2:ALFRED STATE COLLEGE HEALTH SERVICES
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1196
Practice Address - Country:US
Practice Address - Phone:607-587-4200
Practice Address - Fax:607-587-4203
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF300630-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health