Healthcare Provider Details

I. General information

NPI: 1700408200
Provider Name (Legal Business Name): LISA GRANIERI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 BILTMORE AVE
ASHEVILLE NC
28801-4157
US

IV. Provider business mailing address

284 EXECUTIVE PARK DRIE STE. 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 877-277-8873
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number289341
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: