Provider Demographics
NPI:1184714560
Name:GRABER, SYLVIA ANN (ARNP)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:ANN
Last Name:GRABER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:A
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-0118
Mailing Address - Country:US
Mailing Address - Phone:319-367-2241
Mailing Address - Fax:319-367-0549
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:IA
Practice Address - Zip Code:52645-1329
Practice Address - Country:US
Practice Address - Phone:319-367-2241
Practice Address - Fax:319-367-0549
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA099739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39240 WAYLANDOtherWELLMARK BC #
IA39239 WINFIELDOtherWELLMARK BC #
IA3287839Medicaid
IA3287839Medicaid