Provider Demographics
NPI:1194999235
Name:GRANGER, LINDA DENISE
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DENISE
Last Name:GRANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19622 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-6831
Mailing Address - Country:US
Mailing Address - Phone:708-418-5310
Mailing Address - Fax:708-474-7096
Practice Address - Street 1:19622 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-6831
Practice Address - Country:US
Practice Address - Phone:708-418-5310
Practice Address - Fax:708-474-7096
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2935015347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle