Healthcare Provider Details

I. General information

NPI: 1487572236
Provider Name (Legal Business Name): JENNA LAURA GRANAHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SAINT LUKES CENTER DR STE 303
CHESTERFIELD MO
63017-3519
US

IV. Provider business mailing address

121 SAINT LUKES CENTER DR STE 303
CHESTERFIELD MO
63017-3519
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-3278
  • Fax: 314-590-5949
Mailing address:
  • Phone: 314-434-3278
  • Fax: 314-590-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018022981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: