Provider Demographics
NPI:1275513004
Name:GRAFF, SHARON (CNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GRAFF
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2826
Mailing Address - Country:US
Mailing Address - Phone:419-794-3026
Mailing Address - Fax:419-794-3006
Practice Address - Street 1:36115 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1216
Practice Address - Country:US
Practice Address - Phone:734-464-0887
Practice Address - Fax:734-402-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 153276163WG0000X
OHNP-06602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114812406Medicaid
MI114719887Medicaid
OHP00199639OtherRR MEDICARE
OH000000213037OtherANTHEM
OH2286468Medicaid
OH01973OtherPARAMOUNT
MI114812406Medicaid
OH000000213037OtherANTHEM
MI114719887Medicaid