Provider Demographics
NPI:1932770880
Name:GRAFFATO, JENNY MORA (APRN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MORA
Last Name:GRAFFATO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4505
Mailing Address - Country:US
Mailing Address - Phone:504-443-1744
Mailing Address - Fax:504-443-1752
Practice Address - Street 1:3616 S I 10 SERVICE RD W STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1884
Practice Address - Country:US
Practice Address - Phone:504-838-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP220980363LF0000X
LA220980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine