Provider Demographics
NPI:1326253840
Name:GRANGER, MEGAN KATHLEEN
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:GRANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MILITARY AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3434
Mailing Address - Country:US
Mailing Address - Phone:859-797-7367
Mailing Address - Fax:
Practice Address - Street 1:1825 MILITARY AVENUE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-3434
Practice Address - Country:US
Practice Address - Phone:859-797-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator