Healthcare Provider Details

I. General information

NPI: 1356157242
Provider Name (Legal Business Name): NASIR GRANGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 W CREEK RD
INDEPENDENCE OH
44131-2177
US

IV. Provider business mailing address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

V. Phone/Fax

Practice location:
  • Phone: 614-844-3800
  • Fax:
Mailing address:
  • Phone: 614-844-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number602632600323
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: