Healthcare Provider Details

I. General information

NPI: 1639173594
Provider Name (Legal Business Name): JULIE C. GRANNAN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/21/2021
Certification Date: 03/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TECHNOLOGY AVE
NEW ALBANY IN
47150-8548
US

IV. Provider business mailing address

4101 TECHNOLOGY AVE
NEW ALBANY IN
47150-8548
US

V. Phone/Fax

Practice location:
  • Phone: 812-941-4500
  • Fax:
Mailing address:
  • Phone: 812-941-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001841A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: