Provider Demographics
NPI:1336103522
Name:GRANBERG-NILL, DANA HUTCHISON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:HUTCHISON
Last Name:GRANBERG-NILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 NE 81ST TER
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1294
Mailing Address - Country:US
Mailing Address - Phone:816-994-8787
Mailing Address - Fax:816-994-8788
Practice Address - Street 1:9151 NE 81ST TER
Practice Address - Street 2:SUITE 105
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1294
Practice Address - Country:US
Practice Address - Phone:816-994-8787
Practice Address - Fax:816-994-8788
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO115861OtherSTATE LICENSE NUMBER
H42981Medicare UPIN
MA2158003Medicare PIN