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General NPI Number Information
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NPI Number | 1538539614
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Entity Type | Individual
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Provider Name | KIMBERLY GRANA NP
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 311 W LINCOLN ST STE 101
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City | BELLEVILLE
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State | IL
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Zip | 62220-1902
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Country | US
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Telephone | 618-222-3200
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Fax | 618-222-3203
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Provider Business Mailing Address
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Address Line | 311 W LINCOLN ST STE 201
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City | BELLEVILLE
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State | IL
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Zip | 62220-1902
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Country | US
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Telephone | 618-222-3200
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Fax | 618-222-3203
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209013529
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2015021523
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License Number State | MO
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