1689713364 NPI number — MRS. MICHELE GRANEY NURSE PRACTITIONER

Table of content: MRS. MICHELE GRANEY NURSE PRACTITIONER (NPI 1689713364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689713364 NPI number — MRS. MICHELE GRANEY NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANEY
Provider First Name:
MICHELE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAMBERLAND
Provider Other First Name:
MICHELE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER N
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689713364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 SAMOSET ST OFC 1012
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360-4801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-422-8004
Provider Business Mailing Address Fax Number:
781-499-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 NORTH RD STE 2450
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUDBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01776-1172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-287-0810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  215251 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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