Provider Demographics
NPI:1407314925
Name:GRABER, HOLLY MARIE (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:MARIE
Last Name:GRABER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44638-0091
Mailing Address - Country:US
Mailing Address - Phone:330-749-6067
Mailing Address - Fax:
Practice Address - Street 1:3000 ERIE ST S
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7976
Practice Address - Country:US
Practice Address - Phone:330-833-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024389363LF0000X
OHRN.328905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse