Provider Demographics
NPI:1427480771
Name:GRAZIANO, KRISTEN MARIE (FMPHNP)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:MARIE
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:FMPHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD POND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1270
Mailing Address - Country:US
Mailing Address - Phone:412-220-7323
Mailing Address - Fax:
Practice Address - Street 1:300 OLD POND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1270
Practice Address - Country:US
Practice Address - Phone:412-220-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN608338163WP0808X
PASP013043363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN608338OtherREGISTERED NURSE LICENSE
PASP013043OtherCRNP LICENSE NUMBER