Healthcare Provider Details

I. General information

NPI: 1114294998
Provider Name (Legal Business Name): GRACEANNE FORSYTH-KRAJNA MS, RCEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W148N8204 UNIVERSITY DR
MENOMONEE FALLS WI
53051-3826
US

IV. Provider business mailing address

W148N8204 UNIVERSITY DR
MENOMONEE FALLS WI
53051-3826
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-0709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: