Healthcare Provider Details

I. General information

NPI: 1275440216
Provider Name (Legal Business Name): SYDNI NICOLE GRAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 W 21ST ST STE A
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

860 IRONWOOD DR
FARWELL TX
79325-5663
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7577
  • Fax:
Mailing address:
  • Phone: 575-749-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1095356
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: