Healthcare Provider Details

I. General information

NPI: 1902533490
Provider Name (Legal Business Name): STEPHANIE GRAEFE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

827 50TH ST
NORFOLK VA
23508-2019
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7007
  • Fax:
Mailing address:
  • Phone: 757-214-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024184774
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: