Healthcare Provider Details

I. General information

NPI: 1619213618
Provider Name (Legal Business Name): LIZEL ANN GRANADA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10256 OLD GREEN BAY RD FL 3
PLEASANT PRAIRIE WI
53158-2814
US

IV. Provider business mailing address

9555 76TH ST
PLEASANT PRAIRIE WI
53158-1984
US

V. Phone/Fax

Practice location:
  • Phone: 262-551-4160
  • Fax: 262-551-4165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15297
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.009631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: