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General NPI Number Information
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NPI Number | 1114008281
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Entity Type | Individual
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Provider Name | STEPHANIE ALVERA GRANNEMAN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 210 N MARKET ST
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City | MILAN
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State | MO
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Zip | 63556
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Country | US
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Telephone | 660-265-4456
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Fax | 660-265-4627
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Provider Business Mailing Address
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Address Line | 210 N MARKET ST
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City | MILAN
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State | MO
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Zip | 63556-1316
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Country | US
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Telephone | 660-265-4456
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Fax | 660-265-4627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN086431
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License Number State | MO
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