Provider Demographics
NPI:1891033858
Name:GRANICA, LISA JOAN (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JOAN
Last Name:GRANICA
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 1:3500 N 99TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2418
Mailing Address - Country:US
Mailing Address - Phone:414-736-7314
Mailing Address - Fax:
Practice Address - Street 1:3500 N 99TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2418
Practice Address - Country:US
Practice Address - Phone:414-736-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150308-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse