Provider Demographics
NPI:1497783062
Name:GRAA, MIANNE (NP)
Entity Type:Individual
Prefix:
First Name:MIANNE
Middle Name:
Last Name:GRAA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIANNE
Other - Middle Name:
Other - Last Name:JENRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:401 S WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-7102
Mailing Address - Country:US
Mailing Address - Phone:406-723-8051
Mailing Address - Fax:406-723-8063
Practice Address - Street 1:401 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2423
Practice Address - Country:US
Practice Address - Phone:406-723-8051
Practice Address - Fax:406-723-8063
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN17279363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT430695Medicaid
MT37023OtherBCBS
MT430695Medicaid
MTS14836Medicare UPIN