Provider Demographics
NPI:1558007104
Name:GRANER, BAILIE
Entity Type:Individual
Prefix:
First Name:BAILIE
Middle Name:
Last Name:GRANER
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 1:5265 HIGHWAY 1806
Mailing Address - Street 2:
Mailing Address - City:HUFF
Mailing Address - State:ND
Mailing Address - Zip Code:58554-8720
Mailing Address - Country:US
Mailing Address - Phone:701-226-2531
Mailing Address - Fax:
Practice Address - Street 1:5265 HIGHWAY 1806
Practice Address - Street 2:
Practice Address - City:HUFF
Practice Address - State:ND
Practice Address - Zip Code:58554-8720
Practice Address - Country:US
Practice Address - Phone:701-226-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR40265163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26381000Medicaid