Provider Demographics
NPI:1417925363
Name:GRAWE, GLENDA H (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:H
Last Name:GRAWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24847 FASSLER CIR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5767
Mailing Address - Country:US
Mailing Address - Phone:763-439-3390
Mailing Address - Fax:
Practice Address - Street 1:45-549 PLUMERIA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6902
Practice Address - Country:US
Practice Address - Phone:808-775-7204
Practice Address - Fax:808-775-9404
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM41172080P0204X
HI21114208000000X, 2080P0204X
UT186548-12052080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN776115500Medicaid
HI004703Medicaid