MEDICARE: MS. CAMELLA GRANARA FNP-BC, PMHNP-BC

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	041265-23	NH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	041265-23	NH

General Provider Information

NPI Number	:	1629366265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAMELLA GRANARA FNP-BC, PMHNP-BC

Provider Business Mailing Address
First Line	:	20 FOUNDRY ST
Second Line	:	2ND FLR
City	:	CONCORD
State	:	NH
Zip	:	03301-5419
Country	:	US
Telephone Number	:	617-500-5767
Fax Number	:	617-415-2708

Provider Business Practice Location Address
First Line	:	20 FOUNDRY ST
Second Line	:	2ND FLR
City	:	CONCORD
State	:	NH
Zip	:	03301-5419
Country	:	US
Telephone Number	:	617-500-5767
Fax Number	:	617-415-2708

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	02/06/2026

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