Healthcare Provider Details

I. General information

NPI: 1184714560
Provider Name (Legal Business Name): SYLVIA ANN GRABER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYLVIA A MOON

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WASHINGTON ST
NEW LONDON IA
52645-1329
US

IV. Provider business mailing address

PO BOX 118
NEW LONDON IA
52645-0118
US

V. Phone/Fax

Practice location:
  • Phone: 319-367-2241
  • Fax: 319-367-0549
Mailing address:
  • Phone: 319-367-2241
  • Fax: 319-367-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA099739
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: