Provider Demographics
NPI:1700550472
Name:DE LA GRANA, ANNIE L (DNP FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:L
Last Name:DE LA GRANA
Suffix:
Gender:F
Credentials:DNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 WAKE DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4746
Mailing Address - Country:US
Mailing Address - Phone:919-556-4779
Mailing Address - Fax:
Practice Address - Street 1:1655 WAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4746
Practice Address - Country:US
Practice Address - Phone:919-556-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty