Provider Demographics
NPI:1154196996
Name:GRAFF-WARENSKI, NICHOLAS BILL
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BILL
Last Name:GRAFF-WARENSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 JERRY MURPHY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1256
Mailing Address - Country:US
Mailing Address - Phone:719-722-8819
Mailing Address - Fax:
Practice Address - Street 1:2037 JERRY MURPHY RD STE 101
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1256
Practice Address - Country:US
Practice Address - Phone:719-722-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist