Provider Demographics
NPI:1255512190
Name:GRAETER, MICHELLE M (LVN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:GRAETER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 COUNTY ROAD 3590
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-4534
Mailing Address - Country:US
Mailing Address - Phone:254-292-2724
Mailing Address - Fax:
Practice Address - Street 1:292 COUNTY ROAD 3590
Practice Address - Street 2:
Practice Address - City:CHINA SPRING
Practice Address - State:TX
Practice Address - Zip Code:76633-4534
Practice Address - Country:US
Practice Address - Phone:254-292-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse