Provider Demographics
NPI:1609152263
Name:GRAYUM-SCHULTE, VIRGINIA DIANNE (BS)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DIANNE
Last Name:GRAYUM-SCHULTE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:DIANNE
Other - Last Name:SCHULTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:14014 MANCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4514
Mailing Address - Country:US
Mailing Address - Phone:636-391-0015
Mailing Address - Fax:636-391-0015
Practice Address - Street 1:14014 MANCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4514
Practice Address - Country:US
Practice Address - Phone:636-391-0015
Practice Address - Fax:636-391-0015
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003005687247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other