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General NPI Number Information
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NPI Number | 1518845395
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Entity Type | Individual
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Provider Name | MIRI K GRAEFEN
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Gender | Female
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 100 MEDICAL PLZ FL 5
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1366
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Country | US
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Telephone | 636-755-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 160 MAPLE SHADE DR
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City | OLD MONROE
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State | MO
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Zip | 63369-2655
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Country | US
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Telephone | 623-261-9846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 376K00000X
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 376K00000X
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License Number State | IL
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