Provider Demographics
NPI:1487011607
Name:GRANSBURY, PEARL VIRGINIA (CHA III)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:VIRGINIA
Last Name:GRANSBURY
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:AK
Mailing Address - Zip Code:99648
Mailing Address - Country:US
Mailing Address - Phone:907-853-4100
Mailing Address - Fax:907-853-2260
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:AK
Practice Address - Zip Code:99648
Practice Address - Country:US
Practice Address - Phone:907-853-2202
Practice Address - Fax:907-853-2260
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15-1359-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker