Provider Demographics
NPI:1386656007
Name:GRANFIELD, LORRAINE WINDRIDGE (CRNA)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:WINDRIDGE
Last Name:GRANFIELD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 ROBINSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-5022
Mailing Address - Country:US
Mailing Address - Phone:772-285-3457
Mailing Address - Fax:
Practice Address - Street 1:2709 ROBINSON PARK RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-5022
Practice Address - Country:US
Practice Address - Phone:772-285-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2568052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2912OtherBCBS OF FLORIDA
FL3079228-00Medicaid
FL430065561OtherRR MEDICARE
FLG2912OtherBCBS OF FLORIDA