Provider Demographics
NPI:1689713364
Name:GRANEY, MICHELE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:GRANEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:CHAMBERLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER N
Mailing Address - Street 1:131 SAMOSET ST OFC 1012
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4801
Mailing Address - Country:US
Mailing Address - Phone:781-422-8004
Mailing Address - Fax:781-499-2228
Practice Address - Street 1:144 NORTH RD STE 2450
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1172
Practice Address - Country:US
Practice Address - Phone:978-287-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215251363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q12609Medicare UPIN