Provider Demographics
NPI:1275024994
Name:GRAEBER, LAURA JEAN (DNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:GRAEBER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 N 99TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5327
Mailing Address - Country:US
Mailing Address - Phone:602-907-6520
Mailing Address - Fax:
Practice Address - Street 1:824 N 99TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5327
Practice Address - Country:US
Practice Address - Phone:602-907-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health