Provider Demographics
NPI:1861631285
Name:GRANNELL, BOYSIE A (RN)
Entity Type:Individual
Prefix:MR
First Name:BOYSIE
Middle Name:A
Last Name:GRANNELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 BRUNER AVE
Mailing Address - Street 2:1ST FL.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2662
Mailing Address - Country:US
Mailing Address - Phone:914-843-1699
Mailing Address - Fax:
Practice Address - Street 1:3406 BRUNER AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2662
Practice Address - Country:US
Practice Address - Phone:914-843-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse