Stephanie Alvera Granneman, NURSE PRACTITIONER
Individual provider Active NPI Family Nurse Practitioner · Milan, MO
NPI 1114008281 · NPPES record last updated Mar 12, 2008
Key facts
- NPI
- 1114008281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN086431 (MO)
- Practice address
- 210 N Market St
Milan, MO 63556 - Phone
- (660) 265-4456
- Fax
- (660) 265-4627
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130601000030 | MO | Order and Referring Only - Nurse Practitioner | 9931124443 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN086431 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN086431 | MO | Yes |
Addresses
Primary practice location
210 N Market St
Milan, MO 63556
Mailing address
210 N Market St
Milan, MO 63556-1316
Phone (660) 265-4456
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 428230411 | Medicaid | MO | |
| 501720809 | Medicaid | MO | |
| 591720800 | Medicaid | MO |
Other providers in Milan, MO
- Daniel Hoelzel CRTT Inc
- Megan Lynn Duffy
- Dale Essmyer
- Ashley L Gardner
- Glenda Magney
- Green Hills Physical Therapy & Associates, Inc.
- Sherri Lynn Hedges
- High Hope Employment Services, Inc.
- Hulett Enterprises Dba Stovers Residential Care Facility
- Brenna Jeffries
All providers in Milan, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.