Provider Demographics
NPI:1164732111
Name:GRAHE, MEGHAN TERESE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:TERESE
Last Name:GRAHE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 WESTWELL LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2009
Mailing Address - Country:US
Mailing Address - Phone:443-834-2543
Mailing Address - Fax:
Practice Address - Street 1:2111 LAUREL BUSH RD STE H
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6156
Practice Address - Country:US
Practice Address - Phone:410-569-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169308363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics