MEDICARE: TREASA ANN GRANGIER 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
1	364SF0001X	Family Health Clinical Nurse Specialist	28154339A	IN
2	363LF0000X	Family Nurse Practitioner	71004202A	IN

General Provider Information

NPI Number	:	1821340506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREASA ANN GRANGIER FNP

Provider Business Mailing Address
First Line	:	1165 HIDDEN MEADOWS CT
Second Line	:
City	:	SCOTTSBURG
State	:	IN
Zip	:	47170-8714
Country	:	US
Telephone Number	:	812-752-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 PEACH BLOSSOM DR STE 101
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-8380
Country	:	US
Telephone Number	:	812-590-1600
Fax Number	:	812-590-6561

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

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	08/06/2019

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