Provider Demographics
NPI:1609474931
Name:GRANGER, AMANDA LEANN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEANN
Last Name:GRANGER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 THIGPEN RD
Mailing Address - Street 2:
Mailing Address - City:POLLOK
Mailing Address - State:TX
Mailing Address - Zip Code:75969-3629
Mailing Address - Country:US
Mailing Address - Phone:936-240-4096
Mailing Address - Fax:
Practice Address - Street 1:676 THIGPEN RD
Practice Address - Street 2:
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969-3629
Practice Address - Country:US
Practice Address - Phone:936-240-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338048164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse