Provider Demographics
NPI:1528779865
Name:GRAFF, MAKENNA MAY (FNP)
Entity type:Individual
Prefix:MRS
First Name:MAKENNA
Middle Name:MAY
Last Name:GRAFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4493 W HARVEST SUN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-4703
Mailing Address - Country:US
Mailing Address - Phone:801-850-4646
Mailing Address - Fax:
Practice Address - Street 1:275 W 200 N STE 350
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5020
Practice Address - Country:US
Practice Address - Phone:801-383-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11565507-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily