Lisa J Grandon, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703059274 Issued in MI

Practice address

1215 Fulton St E
Grand Rapids, MI 49503-3849

Phone

(616) 742-0351

Fax

(616) 742-0370

NPI assigned

Jun 23, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1902537509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2833 CENTRAL PARK WAY NE APT 204",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 FULTON ST E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033849",
            "telephone_number": "616-742-0351",
            "fax_number": "616-742-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDON",
        "first_name": "LISA",
        "middle_name": "J",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SC1501X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Community Health/Public Health",
            "state": "MI",
            "license": "4703059274",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703059274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa.grandon@usc.salvationarmy.org",
            "affiliation": "N",
            "address_1": "1215 Fulton St E",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495033849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Andrea Marie Grandy, LPC, LLMFT
• Robert Matthew Granett, PHARM.D.
• Jill Marie Granger, LMSW
• Benjamin Carroll Grant, PA-C
• Brittney Taylor Grant, FNP

• Licensed Practical Nurse in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.