Provider Demographics
NPI:1093239279
Name:GRABER, HOLLY ANN (DNP, FNP- BC, APNP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:GRABER
Suffix:
Gender:F
Credentials:DNP, FNP- BC, APNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:169 MADISON AVE STE 2817
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5101
Mailing Address - Country:US
Mailing Address - Phone:888-553-2823
Mailing Address - Fax:888-553-2823
Practice Address - Street 1:423 FORTRESS BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1351
Practice Address - Country:US
Practice Address - Phone:304-225-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA167768363LF0000X
IL277.002189363LF0000X
NE114545363LF0000X
NY354581363LF0000X
INTH0005221363LF0000X
MI4704383781363LF0000X
AZ297799363LF0000X
TX1088698363A00000X
OHAPRN.CNP.0035247363LF0000X
WI7747-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10028954300Medicaid
IL1093239279Medicaid
MI1093239279Medicaid
OH0049051Medicaid