Provider Demographics
NPI:1609846823
Name:GRAEBER, LUANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:LUANNA
Middle Name:
Last Name:GRAEBER
Suffix:
Gender:F
Credentials:PA-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 9
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-0009
Mailing Address - Country:US
Mailing Address - Phone:701-463-2245
Mailing Address - Fax:701-463-6543
Practice Address - Street 1:437 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-7235
Practice Address - Country:US
Practice Address - Phone:701-463-2245
Practice Address - Fax:701-463-6543
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12635Medicaid
ND20686OtherBLUECROSS/BLUE SHIELD
ND20686OtherBLUECROSS/BLUE SHIELD
NDR02202Medicare UPIN