Healthcare Provider Details

I. General information

NPI: 1821340506
Provider Name (Legal Business Name): TREASA ANN GRANGIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 PEACH BLOSSOM DR STE 101
JEFFERSONVILLE IN
47130-8380
US

IV. Provider business mailing address

1165 HIDDEN MEADOWS CT
SCOTTSBURG IN
47170-8714
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-1600
  • Fax: 812-590-6561
Mailing address:
  • Phone: 812-752-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number28154339A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: