Individual
LAURIE GRANATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 955-6353
Mailing address
PO BOX 64382, BALTIMORE, MD 21264-4382
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R080509
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687401100
—
MD
Enumeration date
04/17/2006
Last updated
01/09/2014
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