Individual
JACQUELINE GRANESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1065 ASHLEY ST STE 200, BOWLING GREEN, KY 42103-3401
(270) 843-3376
(270) 780-0496
Mailing address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 781-5111
(270) 843-3376
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
42560
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100072860
—
KY
Enumeration date
07/12/2007
Last updated
07/21/2022
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