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General NPI Number Information
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NPI Number | 1487004297
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Entity Type | Individual
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Provider Name | MELISSA ANN GRANBERRY NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 1830 BILLY G WEBB
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City | PORTLAND
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State | TX
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Zip | 78374-3707
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Country | US
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Telephone | 361-643-2518
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Fax | 361-643-2629
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Provider Business Mailing Address
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Address Line | 908 S KOSSUTH ST
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City | ROCKPORT
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State | TX
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Zip | 78382-4635
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Country | US
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Telephone | 361-944-6767
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP131128
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License Number State | TX
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