MEDICARE: MRS. CYNTHIA GRANATA APRN

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
1	363LF0000X	Family Nurse Practitioner	F06161407	OH

General Provider Information

NPI Number	:	1487108056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA GRANATA APRN

Provider Business Mailing Address
First Line	:	775 BECKLEY FARM WAY
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9491
Country	:	US
Telephone Number	:	937-232-2428
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 S EAST ST
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-2378
Country	:	US
Telephone Number	:	513-695-1468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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