Provider Demographics
NPI:1639173198
Name:GRAEBNER, JANE ELLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:GRAEBNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 W WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2255
Mailing Address - Country:US
Mailing Address - Phone:740-363-4373
Mailing Address - Fax:740-363-9560
Practice Address - Street 1:1871 W WILLIAM ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2255
Practice Address - Country:US
Practice Address - Phone:740-363-4373
Practice Address - Fax:740-363-9560
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-11
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002064213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80523Medicare UPIN
OH0485790001Medicare NSC
OH0509912Medicare PIN