=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396941969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERI DANA DEGRAZIA CNM, WHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 11/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 5TH AVE THIRD FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-366-4765
-----------------------------------------------------
Fax | 212-229-1020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 5TH AVE SUITE 3
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-366-4765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | F420853-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | F001272-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------