Provider Demographics
NPI:1942429105
Name:GRANATA, JILL (WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:GRANATA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32188 LEELANE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2428
Mailing Address - Country:US
Mailing Address - Phone:248-752-6864
Mailing Address - Fax:
Practice Address - Street 1:19401 HUBBARD DRIVE, SUITE 106
Practice Address - Street 2:HENRY FORD MEDICAL CENTER FAIRLANE
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2699
Practice Address - Country:US
Practice Address - Phone:313-982-8243
Practice Address - Fax:313-982-8686
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167030363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health