Healthcare Provider Details

I. General information

NPI: 1588110779
Provider Name (Legal Business Name): ANGELA GRANTMAIER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OLD BANK RD STE 100
MILFORD OH
45150-2443
US

IV. Provider business mailing address

201 OLD BANK RD STE 100
MILFORD OH
45150-2443
US

V. Phone/Fax

Practice location:
  • Phone: 513-683-5700
  • Fax: 513-683-5701
Mailing address:
  • Phone: 513-683-5700
  • Fax: 513-683-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN.274825
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019875
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: