Provider Demographics
NPI:1861194334
Name:GRANADOS, ELOISE E (LPN)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:E
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 S ATKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-7154
Mailing Address - Country:US
Mailing Address - Phone:575-578-4826
Mailing Address - Fax:
Practice Address - Street 1:1107 S ATKINSON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-7154
Practice Address - Country:US
Practice Address - Phone:575-578-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM22688164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse