Provider Demographics
NPI:1396941969
Name:DEGRAZIA, PERI DANA (CNM, WHNP)
Entity type:Individual
Prefix:MS
First Name:PERI
Middle Name:DANA
Last Name:DEGRAZIA
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:MS
Other - First Name:PERI
Other - Middle Name:DANA
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1009
Mailing Address - Country:US
Mailing Address - Phone:212-366-4765
Mailing Address - Fax:
Practice Address - Street 1:103 5TH AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1009
Practice Address - Country:US
Practice Address - Phone:212-366-4765
Practice Address - Fax:212-229-1020
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420853-1363LW0102X
NYF001272-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF001272-1OtherCNM LICENSE NUMBER
NY565709-1OtherRN LICENSE NUMBER