Provider Demographics
NPI:1982565883
Name:GRAUSE, KELLIE MICHELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:MICHELLE
Last Name:GRAUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:MICHELLE
Other - Last Name:GRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:180 10TH ST SE STE 201
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-2557
Mailing Address - Country:US
Mailing Address - Phone:712-546-4624
Mailing Address - Fax:712-546-9395
Practice Address - Street 1:180 10TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-2557
Practice Address - Country:US
Practice Address - Phone:712-546-4624
Practice Address - Fax:712-546-9395
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA144107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse