Individual
KELLY K GRANNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 570-2000
Mailing address
60 REVERE DR STE 100, NORTHBROOK, IL 60062-1590
(224) 306-1879
(224) 306-1878
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019940
IL
Other
Enumeration date
08/27/2019
Last updated
07/02/2024
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