Provider Demographics
NPI:1255183158
Name:GRANGER, STEPHANIE DIANE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANE
Last Name:GRANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIANE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 CHURCHILL CT
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1334
Mailing Address - Country:US
Mailing Address - Phone:978-846-4765
Mailing Address - Fax:
Practice Address - Street 1:3 CHURCHILL CT
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1334
Practice Address - Country:US
Practice Address - Phone:978-846-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula