Provider Demographics
NPI:1942479647
Name:GRANEY, NICOLE MARIE (CNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:GRANEY
Suffix:
Gender:F
Credentials:CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-3706
Mailing Address - Country:US
Mailing Address - Phone:708-684-1358
Mailing Address - Fax:708-684-7040
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:188 NORTH OFFICE BUILDING
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-1358
Practice Address - Fax:708-684-7040
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL346S00000X364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist