Provider Demographics
NPI:1780710558
Name:GRANGE, JANET JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:JOAN
Last Name:GRANGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E GOLD COAST RD
Mailing Address - Street 2:SUITE 329
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4194
Mailing Address - Country:US
Mailing Address - Phone:402-934-9323
Mailing Address - Fax:402-934-9471
Practice Address - Street 1:401 E GOLD COAST RD
Practice Address - Street 2:SUITE 329
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4194
Practice Address - Country:US
Practice Address - Phone:402-934-9323
Practice Address - Fax:402-934-9471
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19630208600000X
IA33814208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE34173OtherBCBS OF NEBRASKA #
NE47083782500Medicaid
IA2224212Medicaid
NE17-81009OtherUNITED HEALTH CARE #
NE34173OtherBCBS OF NEBRASKA #
NE273680GRMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
IAI8957Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
NE22048488Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
NE17-81009OtherUNITED HEALTH CARE #
IAI8956Medicare ID - Type UnspecifiedGROUP MEDICARE #