MEDICARE: LAURA JEAN GRAEBER DNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP11310	AZ

General Provider Information

NPI Number	:	1275024994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN GRAEBER DNP

Provider Business Mailing Address
First Line	:	824 N 99TH AVE STE 108
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-5327
Country	:	US
Telephone Number	:	602-907-6520
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 N 99TH AVE STE 108
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-5327
Country	:	US
Telephone Number	:	602-907-6520
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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