Healthcare Provider Details

I. General information

NPI: 1982511341
Provider Name (Legal Business Name): MRS. ALEXIS GRANUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 W MORTEN AVE
GLENDALE AZ
85307-1722
US

IV. Provider business mailing address

10720 W MORTEN AVE
GLENDALE AZ
85307-1722
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-6770
  • Fax:
Mailing address:
  • Phone: 623-299-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: