Provider Demographics
NPI:1386913291
Name:GRAICHEN, SANDRA ANN
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANN
Last Name:GRAICHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5300
Mailing Address - Country:US
Mailing Address - Phone:315-338-5314
Mailing Address - Fax:315-338-5306
Practice Address - Street 1:620 E BLOOMFIELD ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5300
Practice Address - Country:US
Practice Address - Phone:315-338-5314
Practice Address - Fax:315-338-5306
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486052-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool