Provider Demographics
NPI:1679681951
Name:GRAF, ELLEN V (MSN FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:V
Last Name:GRAF
Suffix:
Gender:F
Credentials:MSN FNP-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 306
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0306
Mailing Address - Country:US
Mailing Address - Phone:207-433-7854
Mailing Address - Fax:
Practice Address - Street 1:TOGUS VA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-623-4787
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER047500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004074Medicaid
KYPO3383Medicare UPIN
KY78004074Medicaid