Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MT2414 | ME |
NPI | 1750673307 |
---|---|
Provider Name | Laurie Ann Granger |
First Address | Gray, ME 04039-9541 |
Second Address | Gray, ME 04039-9541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 13/05/2011 |