| Doctor Name: | JAMIE COY GRANGE |
| NPI Number: | 1528438140 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 95341561206 |
| Business Practice Address: | 2380 N 400 E Suite D North Logan, UT - 843416000 |
| Business Phone Number: | 4357537880 |
| Business Fax Number: | |
| Mailing Address: | 530 N 1420 E, LOGAN |
| State: | UT |
| Postal Code: | 843214372 |
| Phone Number: | 4357643116 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2015 |
| NPI Last Update Date: | 09/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 95341561206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |