Provider Demographics
NPI:1639675002
Name:GRANITTO, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GRANITTO
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 1:14630 KEENELAND CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3771
Mailing Address - Country:US
Mailing Address - Phone:301-520-7474
Mailing Address - Fax:
Practice Address - Street 1:14630 KEENELAND CIR
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-3771
Practice Address - Country:US
Practice Address - Phone:301-520-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1047999163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health