Provider Demographics
NPI:1760941025
Name:GRAZIANI, MANDI JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:JO
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1024
Mailing Address - Country:US
Mailing Address - Phone:330-407-3893
Mailing Address - Fax:
Practice Address - Street 1:717 DALE AVE NW
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:OH
Practice Address - Zip Code:44680-9736
Practice Address - Country:US
Practice Address - Phone:330-407-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.119646.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty