Individual
LINETTE I GRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
1025 MANCHESTER AVE, WABASH, IN 46992-1425
(260) 563-7421
(260) 569-2284
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003654
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201007920
—
IN
01
—
P01123184
RR MEDICARE
IN
Enumeration date
06/11/2006
Last updated
11/10/2017
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