Individual
NICOLE COLEEEN GRANADOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
395 W COUGAR BLVD STE 105, PROVO, UT 84604-3311
(805) 712-0070
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10404764-4405
UT
363LF0000X
Family Nurse Practitioner
10404764-4405
UT
Other
Enumeration date
04/15/2022
Last updated
07/13/2022
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