Provider Demographics
NPI:1629366265
Name:GRANARA, CAMELLA L (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CAMELLA
Middle Name:L
Last Name:GRANARA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 OLD WILTON RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3120
Mailing Address - Country:US
Mailing Address - Phone:603-732-1600
Mailing Address - Fax:603-672-4341
Practice Address - Street 1:117 OLD WILTON RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3120
Practice Address - Country:US
Practice Address - Phone:603-732-1600
Practice Address - Fax:603-672-4341
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041265-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily