Provider Demographics
NPI:1447814132
Name:GRANT, ELIZABETH WHITE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WHITE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 EMERSON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2627
Mailing Address - Country:US
Mailing Address - Phone:415-516-2426
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1400
Practice Address - Country:US
Practice Address - Phone:612-672-7700
Practice Address - Fax:612-672-4244
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010377363LF0000X
MN11664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily