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NPI Code Detail

MEDICARE: SOPHIA GRABEN CPNP-AC

MEDICARE: SOPHIA GRABEN CPNP-AC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner1001887CO

General Provider Information

NPI Number : 1063341584
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA GRABEN CPNP-AC
Provider Business Mailing Address
First Line : 4090 BRIARGATE PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7815
Country : US
Telephone Number : 719-305-4217
Fax Number :
Provider Business Practice Location Address
First Line : 4090 BRIARGATE PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7815
Country : US
Telephone Number : 719-305-4217
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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