Provider Demographics
NPI:1386833366
Name:GRASKY, STEPHANIE L (PA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:GRASKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4811 E GRANT RD
Mailing Address - Street 2:STE 261
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2771
Mailing Address - Country:US
Mailing Address - Phone:520-297-1345
Mailing Address - Fax:520-297-3539
Practice Address - Street 1:5670 N PROFESSIONAL PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7878
Practice Address - Country:US
Practice Address - Phone:520-618-1010
Practice Address - Fax:520-784-7040
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ687954Medicaid
AZZ151145Medicare PIN