Provider Demographics
NPI:1386277838
Name:GRAUNKE, NICHOLAS EDWARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:GRAUNKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2350 N LAKE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4528
Mailing Address - Country:US
Mailing Address - Phone:414-298-7280
Mailing Address - Fax:
Practice Address - Street 1:2350 N LAKE DR STE 206
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-298-7280
Practice Address - Fax:414-298-7281
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI5182-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant