Provider Demographics
NPI:1336252071
Name:GRAESSER, NANCY L (DO)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:GRAESSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 DILEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9612
Mailing Address - Country:US
Mailing Address - Phone:614-835-3838
Mailing Address - Fax:614-834-4750
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-835-3838
Practice Address - Fax:614-834-4750
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004238G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0638895Medicaid
OHA16675Medicare UPIN
0690656Medicare PIN