Provider Demographics
NPI:1659105369
Name:GRANHOLM, SALLY CLAIRE (RN)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:CLAIRE
Last Name:GRANHOLM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-2628
Mailing Address - Country:US
Mailing Address - Phone:207-620-6829
Mailing Address - Fax:
Practice Address - Street 1:901 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-2628
Practice Address - Country:US
Practice Address - Phone:207-620-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN76997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse