Provider Demographics
NPI:1356894745
Name:GRANGER, REBECCA DANIELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DANIELLE
Last Name:GRANGER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:DANIELLE
Other - Last Name:BOHLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1522 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3533
Mailing Address - Country:US
Mailing Address - Phone:419-207-1085
Mailing Address - Fax:
Practice Address - Street 1:1522 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3533
Practice Address - Country:US
Practice Address - Phone:419-207-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily