Healthcare Provider Details

I. General information

NPI: 1508553264
Provider Name (Legal Business Name): MARIA GRABNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N DETROIT ST
LAGRANGE IN
46761-1158
US

IV. Provider business mailing address

PO BOX 236
LAGRANGE IN
46761-0236
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2133
  • Fax: 260-463-3775
Mailing address:
  • Phone: 260-463-2133
  • Fax: 260-463-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00000000A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: