Provider Demographics
NPI:1639157811
Name:DEGRAFF, PRISCILLA (NP)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:DEGRAFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S. WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-8803
Mailing Address - Country:US
Mailing Address - Phone:509-486-3107
Mailing Address - Fax:509-486-3119
Practice Address - Street 1:203 S. WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-8803
Practice Address - Country:US
Practice Address - Phone:509-486-3107
Practice Address - Fax:509-486-3119
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9607540Medicaid
WA0224734OtherL&I
WA8868773Medicare PIN
WA0224734OtherL&I