Provider Demographics
NPI:1730330036
Name:GRENNAN, STEPHANIE LYNN (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:GRENNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N BRADY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1804
Mailing Address - Country:US
Mailing Address - Phone:785-263-4131
Mailing Address - Fax:785-263-2774
Practice Address - Street 1:1111 N BRADY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1804
Practice Address - Country:US
Practice Address - Phone:785-263-4131
Practice Address - Fax:785-263-2774
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant