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General NPI Number Information
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NPI Number | 1386296044
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Entity Type | Individual
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Provider Name | ANDREA GRANO CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 465 SAINT MICHAELS DR
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City | SANTA FE
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State | NM
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Zip | 87505-7670
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Country | US
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Telephone | 505-913-4901
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Fax | 505-913-6426
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Provider Business Mailing Address
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Address Line | 4485 GOLDEN EAGLE LOOP NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-7689
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Country | US
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Telephone | 505-614-6919
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 56915
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License Number State | NM
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