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General NPI Number Information
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NPI Number | 1134291438
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Entity Type | Individual
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Provider Name | DENIESE ELAINE JENSEN GRANVILLE DPM
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 55 S STATE ST STE 3220
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3975
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Country | US
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Telephone | 503-635-7742
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Fax | 503-635-8495
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Provider Business Mailing Address
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Address Line | 55 S STATE ST STE 3220
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3975
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Country | US
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Telephone | 503-635-7742
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Fax | 503-635-8495
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00223
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License Number State | OR
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