Provider Demographics
NPI:1831252535
Name:GRANEY, JOANNE MARGARET (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARGARET
Last Name:GRANEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:MARGARET
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:9749 SIERRA MADRE RD
Mailing Address - Street 2:SPRING VALLEY
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1329
Mailing Address - Country:US
Mailing Address - Phone:619-741-0376
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-531-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily