MEDICARE: ELIZABETH KATHLEEN GRAUSTEIN FNP-BC

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
1	207Q00000X	Family Medicine Physician	AP139865	TX
2	363LF0000X	Family Nurse Practitioner	AP139865	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982169264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KATHLEEN GRAUSTEIN FNP-BC

Provider Business Mailing Address
First Line	:	413 E RAILROAD AVE
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4133
Country	:	US
Telephone Number	:	956-202-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 E RAILROAD AVE
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4133
Country	:	US
Telephone Number	:	956-202-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	03/11/2026

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