Basic Information
| Provider Information | |||||||||
| NPI: | 1366588337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANGER | ||||||||
| FirstName: | EDNA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4830 N.W. 73RD ST | ||||||||
| Address2: | |||||||||
| City: | CHIEFLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326265301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524930232 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN9244383 | FL | Y | Nursing Service Providers | Registered Nurse | General Practice | 163WG0000X | 0001053233 | VA | N | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.