Provider Demographics
NPI:1801043617
Name:GRACZYK, MARIANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANN
Middle Name:
Last Name:GRACZYK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIANN
Other - Middle Name:
Other - Last Name:DECKOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1 LEO MOSS DR
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1100
Mailing Address - Country:US
Mailing Address - Phone:716-373-8050
Mailing Address - Fax:716-701-3737
Practice Address - Street 1:1 LEO MOSS DR
Practice Address - Street 2:SUITE 4010
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1100
Practice Address - Country:US
Practice Address - Phone:716-373-8050
Practice Address - Fax:716-701-3737
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331428-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily