Provider Demographics
NPI:1831604198
Name:GRAUER, KRISTEN ELIZABETH (CPM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:GRAUER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-1133
Mailing Address - Country:US
Mailing Address - Phone:405-885-7662
Mailing Address - Fax:405-294-4078
Practice Address - Street 1:609 S SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-1133
Practice Address - Country:US
Practice Address - Phone:405-885-7662
Practice Address - Fax:405-294-4078
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17080004175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay