Provider Demographics
NPI:1174241574
Name:GRANT, ELAINA (RDH)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5430
Mailing Address - Country:US
Mailing Address - Phone:703-609-1182
Mailing Address - Fax:
Practice Address - Street 1:9071 CENTER ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5430
Practice Address - Country:US
Practice Address - Phone:703-609-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist