Provider Demographics
NPI:1851301626
Name:GRAEFE, WENDY ANN (CNM)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:GRAEFE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 MARION ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3028
Mailing Address - Country:US
Mailing Address - Phone:757-739-9239
Mailing Address - Fax:
Practice Address - Street 1:817 GREENBRIER PKWY STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3823
Practice Address - Country:US
Practice Address - Phone:757-548-2800
Practice Address - Fax:757-548-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166287367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006755M59Medicare ID - Type Unspecified