Provider Demographics
NPI:1801899349
Name:GRANTHAM, DANIELLA DEONA (WHNP)
Entity type:Individual
Prefix:MRS
First Name:DANIELLA
Middle Name:DEONA
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SOLAR WAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-2204
Mailing Address - Country:US
Mailing Address - Phone:940-391-0235
Mailing Address - Fax:
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:STE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-993-6000
Practice Address - Fax:361-993-3676
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX559826363LW0102X
TXAP108955363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120095808Medicaid
TX120095808Medicaid
TX8D1307Medicare ID - Type Unspecified