Provider Demographics
NPI:1487108056
Name:GRANATA, CYNTHIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:GRANATA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 BECKLEY FARM WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9491
Mailing Address - Country:US
Mailing Address - Phone:937-232-2428
Mailing Address - Fax:
Practice Address - Street 1:416 S EAST ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-2378
Practice Address - Country:US
Practice Address - Phone:513-695-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF06161407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily