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NPI Code Detail

MEDICARE: KIMBERLY L GRANGER RNC MSN FNP

MEDICARE: KIMBERLY L GRANGER RNC MSN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner106-033WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245227248
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY L GRANGER RNC MSN FNP
Provider Business Mailing Address
First Line : 3807 SPRING ST
Second Line :
City : RACINE
State : WI
Zip : 53405
Country : US
Telephone Number : 262-687-8282
Fax Number : 262-687-6737
Provider Business Practice Location Address
First Line : 3807 SPRING ST
Second Line :
City : RACINE
State : WI
Zip : 53405-1667
Country : US
Telephone Number : 262-687-8282
Fax Number : 262-687-6737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 09/22/2010

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