Healthcare Provider Details

I. General information

NPI: 1376157941
Provider Name (Legal Business Name): JULIE ANN GRAGER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23715 LITTLE MACK AVE
SAINT CLAIR SHORES MI
48080-1181
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 586-447-8021
  • Fax:
Mailing address:
  • Phone:
  • Fax: 947-522-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704292951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: