Healthcare Provider Details

I. General information

NPI: 1629366265
Provider Name (Legal Business Name): CAMELLA GRANARA FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GREEN ST STE 2
CONCORD NH
03301-4000
US

IV. Provider business mailing address

51 ELM ST STE 107
LACONIA NH
03246-2415
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2985
  • Fax: 603-225-6160
Mailing address:
  • Phone: 617-500-5767
  • Fax: 617-415-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041265-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041265-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: