Individual
DENIESE ELAINE JENSEN GRANVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
55 S STATE ST STE 3220, LAKE OSWEGO, OR 97034-3975
(503) 635-7742
(503) 635-8495
Mailing address
55 S STATE ST STE 3220, LAKE OSWEGO, OR 97034-3975
(503) 635-7742
(503) 635-8495
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00223
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038377
—
OR
Enumeration date
11/14/2006
Last updated
04/22/2020
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