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General NPI Number Information
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NPI Number | 1528921087
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Entity Type | Individual
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Provider Name | MICHELE BOUBEDE GRANITO R.N., I.B.C.L.C.
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 301 BUSHY CREEK RD. 106
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City | CEDAR PARK
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State | TX
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Zip | 78613
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Country | US
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Telephone | 512-765-9959
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Fax |
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Provider Business Mailing Address
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Address Line | 301 BUSHY CREEK RD. 106
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City | CEDAR PARK
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State | TX
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Zip | 78613
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Country | US
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Telephone | 512-765-9959
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 1188070
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License Number State | TX
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