MEDICARE: KAYLEEN M GRASHOFF NP

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	363LP2300X	Primary Care Nurse Practitioner	28241226A	IN
2	363LF0000X	Family Nurse Practitioner	71014870A	IN

General Provider Information

NPI Number	:	1487421251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEEN M GRASHOFF NP

Provider Business Mailing Address
First Line	:	6515 STELLHORN RD STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5436
Country	:	US
Telephone Number	:	260-458-3212
Fax Number	:	260-458-3214

Provider Business Practice Location Address
First Line	:	6515 STELLHORN RD STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5436
Country	:	US
Telephone Number	:	260-458-3212
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	04/30/2024

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