Provider Demographics
NPI:1912305673
Name:GRAUNKE, VENESE ANN (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:VENESE
Middle Name:ANN
Last Name:GRAUNKE
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BLACKMORE RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3345
Mailing Address - Country:US
Mailing Address - Phone:307-233-6000
Mailing Address - Fax:307-233-6089
Practice Address - Street 1:428 S DURBIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2829
Practice Address - Country:US
Practice Address - Phone:307-337-4284
Practice Address - Fax:307-224-3436
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22078.1425363LW0102X
CA95001809363LW0102X
WY1245363LX0106X
WY1424363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5933529OtherUNITED HEALTHCARE
WYW27952Medicare PIN