Healthcare Provider Details

I. General information

NPI: 1760941025
Provider Name (Legal Business Name): MANDI JO GRAZIANI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 DALE AVE NW
STRASBURG OH
44680-9736
US

IV. Provider business mailing address

110 E 20TH ST
DOVER OH
44622-1024
US

V. Phone/Fax

Practice location:
  • Phone: 330-407-3893
  • Fax:
Mailing address:
  • Phone: 330-407-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.119646.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: