MEDICARE: MR. BOYSIE A. GRANNELL RN

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	163W00000X	Registered Nurse	536701	NY

General Provider Information

NPI Number	:	1861631285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BOYSIE A. GRANNELL RN

Provider Business Mailing Address
First Line	:	3406 BRUNER AVE
Second Line	:	1ST FL.
City	:	BRONX
State	:	NY
Zip	:	10469-2662
Country	:	US
Telephone Number	:	914-843-1699
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 BRUNER AVE
Second Line	:	1ST FL.
City	:	BRONX
State	:	NY
Zip	:	10469-2662
Country	:	US
Telephone Number	:	914-843-1699
Fax Number	:

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

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	02/09/2009

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