Provider Demographics
NPI:1487670840
Name:GRANNER, STACY ANN (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:GRANNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:TSCHANNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-351-1448
Mailing Address - Fax:319-351-9367
Practice Address - Street 1:1360 N DODGE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-6104
Practice Address - Country:US
Practice Address - Phone:319-351-1448
Practice Address - Fax:319-351-9367
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics