Provider Demographics
NPI:1164288700
Name:GRANJA, SARAH DIANE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DIANE
Last Name:GRANJA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 S CRIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-7250
Mailing Address - Country:US
Mailing Address - Phone:702-326-0986
Mailing Address - Fax:
Practice Address - Street 1:394 W MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2078
Practice Address - Country:US
Practice Address - Phone:801-796-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12717210-4402176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty