Provider Demographics
NPI:1376727172
Name:GRANA, JENNIFER LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:GRANA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N NYES RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3247
Mailing Address - Country:US
Mailing Address - Phone:717-214-6545
Mailing Address - Fax:717-531-0639
Practice Address - Street 1:121 N NYES RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3247
Practice Address - Country:US
Practice Address - Phone:717-214-6545
Practice Address - Fax:717-531-0639
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127224Medicaid
ILIL3374049Medicare PIN