Healthcare Provider Details

I. General information

NPI: 1053287490
Provider Name (Legal Business Name): SAMANTHA JO GRAF DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LILAC DR N STE 140
GOLDEN VALLEY MN
55422-4791
US

IV. Provider business mailing address

11237 PRESIDENT DR NE
BLAINE MN
55434-1774
US

V. Phone/Fax

Practice location:
  • Phone: 763-465-0500
  • Fax:
Mailing address:
  • Phone: 612-805-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13563
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: