NPI 1306982780

Suzette M Grant, INDIVIDUAL

Practitioner Preferred Provider Organization Columbia Falls, ME

Practice location

Address: 860 Tibbettstown Rd, Columbia Falls, ME 04623-5021
Phone: (207) 483-2883

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 3002032 (ME)

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Registry record

NPI: 1306982780
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Jan 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.