Provider Demographics
NPI:1447484290
Name:GRANGER, TAMIE LEA
Entity type:Individual
Prefix:
First Name:TAMIE
Middle Name:LEA
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 1:15112 SUNNINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3818
Mailing Address - Country:US
Mailing Address - Phone:512-364-2945
Mailing Address - Fax:512-248-8611
Practice Address - Street 1:15112 SUNNINGDALE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-3818
Practice Address - Country:US
Practice Address - Phone:512-364-2945
Practice Address - Fax:512-248-8611
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist