Provider Demographics
NPI:1659072585
Name:GRANADOS, JOANA ROSIBEL (RN)
Entity Type:Individual
Prefix:
First Name:JOANA
Middle Name:ROSIBEL
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1402
Mailing Address - Country:US
Mailing Address - Phone:631-575-8197
Mailing Address - Fax:
Practice Address - Street 1:10 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1402
Practice Address - Country:US
Practice Address - Phone:631-575-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY873483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse