Basic Information
Provider Information
NPI: 1285368571
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRANT
FirstName: BRITTNEY
MiddleName: TAYLOR
NamePrefix: MRS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 MICHIGAN ST NE
Address2: MC 845
City: GRAND RAPIDS
State: MI
PostalCode: 49503
CountryCode: US
TelephoneNumber: 6164866790
FaxNumber:  
Practice Location
Address1: 2750 E BELTLINE AVE NE FL 1
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495258614
CountryCode: US
TelephoneNumber: 6163916271
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2022
LastUpdateDate: 10/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4704334889MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home