Provider Demographics
NPI:1982169264
Name:GRAUSTEIN, ELIZABETH KATHLEEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:GRAUSTEIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHIE
Other - Middle Name:
Other - Last Name:GRAUSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856-0279
Mailing Address - Country:US
Mailing Address - Phone:325-216-9581
Mailing Address - Fax:325-766-7292
Practice Address - Street 1:626 N AVENUE F
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856
Practice Address - Country:US
Practice Address - Phone:325-216-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139865207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395973601Medicaid