Provider Demographics
NPI:1750673307
Name:GRANGER, LAURIE ANN (LMT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:GRANGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9541
Mailing Address - Country:US
Mailing Address - Phone:207-740-6487
Mailing Address - Fax:
Practice Address - Street 1:4 WEYMOUTH RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9541
Practice Address - Country:US
Practice Address - Phone:207-740-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2414175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath