Provider Demographics
NPI:1750073474
Name:GRANVILLE, SHANIKA
Entity type:Individual
Prefix:
First Name:SHANIKA
Middle Name:
Last Name:GRANVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORRIS CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97114
Mailing Address - Country:US
Mailing Address - Phone:503-935-6862
Mailing Address - Fax:
Practice Address - Street 1:107 NORRIS CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OR
Practice Address - Zip Code:97114
Practice Address - Country:US
Practice Address - Phone:503-935-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula