Provider Demographics
NPI:1073047890
Name:GRANATA, ELIZABETH J (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:GRANATA
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:20 CUMBERLAND HILL RD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4854
Mailing Address - Country:US
Mailing Address - Phone:401-765-4100
Mailing Address - Fax:401-765-2300
Practice Address - Street 1:20 CUMBERLAND HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4883
Practice Address - Country:US
Practice Address - Phone:401-765-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPA00944OtherSTATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH