MEDICARE: DR. NANCY AEREN GRAU PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	812	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033124722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY AEREN GRAU PH.D.

Provider Business Mailing Address
First Line	:	714 SOLANO DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3383
Country	:	US
Telephone Number	:	505-385-0225
Fax Number	:	505-255-3704

Provider Business Practice Location Address
First Line	:	404 SAN MATEO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5547
Country	:	US
Telephone Number	:	505-385-0225
Fax Number	:	505-255-3704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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