Individual
STEPHANIE ALVERA GRANNEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
210 N MARKET ST, MILAN, MO 63556
(660) 265-4456
(660) 265-4627
Mailing address
210 N MARKET ST, MILAN, MO 63556-1316
(660) 265-4456
(660) 265-4627
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN086431
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428230411
—
MO
05
—
501720809
—
MO
05
—
591720800
—
MO
Enumeration date
10/17/2006
Last updated
03/12/2008
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