Provider Demographics
NPI:1679112775
Name:GRANT, CELENA CORINNE (RN)
Entity type:Individual
Prefix:
First Name:CELENA
Middle Name:CORINNE
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MEIGS RD # A348
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1900
Mailing Address - Country:US
Mailing Address - Phone:805-770-0956
Mailing Address - Fax:
Practice Address - Street 1:315 MEIGS RD # A348
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1900
Practice Address - Country:US
Practice Address - Phone:805-770-0956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95131501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse