MEDICARE: MICHELLE M GRAETER LVN

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	164W00000X	Licensed Practical Nurse	148221	TX

General Provider Information

NPI Number	:	1255512190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M GRAETER LVN

Provider Business Mailing Address
First Line	:	292 COUNTY ROAD 3590
Second Line	:
City	:	CHINA SPRING
State	:	TX
Zip	:	76633-4534
Country	:	US
Telephone Number	:	254-292-2724
Fax Number	:

Provider Business Practice Location Address
First Line	:	292 COUNTY ROAD 3590
Second Line	:
City	:	CHINA SPRING
State	:	TX
Zip	:	76633-4534
Country	:	US
Telephone Number	:	254-292-2724
Fax Number	:

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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