| Doctor Name: | STEPHANIE ALVERA GRANNEMAN |
| NPI Number: | 1114008281 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | RN086431 |
| Business Practice Address: | 210 N Market St Milan, MO - 63556 |
| Business Phone Number: | 6602654456 |
| Business Fax Number: | 6602654627 |
| Mailing Address: | 210 N Market St, MILAN |
| State: | MO |
| Postal Code: | 635561316 |
| Phone Number: | 6602654456 |
| Fax Number: | 6602654627 |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 03/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN086431 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |