Provider Demographics
NPI:1124157656
Name:GRABO, THERESA NANCY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:NANCY
Last Name:GRABO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 LA GRANGE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1619
Mailing Address - Country:US
Mailing Address - Phone:570-654-6687
Mailing Address - Fax:570-718-1488
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1212
Practice Address - Country:US
Practice Address - Phone:570-714-1444
Practice Address - Fax:570-718-1488
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF331267-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily