Provider Demographics
NPI:1639199235
Name:GRANSTON, DAYNA (RN, RXN, CNS, APRN)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:GRANSTON
Suffix:
Gender:F
Credentials:RN, RXN, CNS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HAWTHORN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2144
Mailing Address - Country:US
Mailing Address - Phone:303-443-9634
Mailing Address - Fax:
Practice Address - Street 1:1634 WALNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5400
Practice Address - Country:US
Practice Address - Phone:303-818-8263
Practice Address - Fax:844-272-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91024163W00000X
CORXN-0001430-CNS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00284716OtherRAILROAD MEDICARE
Q50121Medicare UPIN
C802712Medicare ID - Type Unspecified