Healthcare Provider Details

I. General information

NPI: 1912824988
Provider Name (Legal Business Name): JAMIE LEAH GRANATOWICZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 O ST STE 100
LINCOLN NE
68510-2575
US

IV. Provider business mailing address

18408 HAMPTON DR
OMAHA NE
68136-2166
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-5972
  • Fax:
Mailing address:
  • Phone: 402-450-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117019
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: