Basic Information
| Provider Information | |||||||||
| NPI: | 1275513004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAFF | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | |||||||||
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| Credential: | C.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 E INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435372826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197943026 | ||||||||
| FaxNumber: | 4197943006 | ||||||||
| Practice Location | |||||||||
| Address1: | 36115 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344640887 | ||||||||
| FaxNumber: | 7344020254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN. 153276 | OH | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | NP-06602 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 114812406 | 05 | MI | MEDICAID | 114719887 | 05 | MI | MEDICAID | P00199639 | 01 | OH | RR MEDICARE | OTHER | 000000213037 | 01 | OH | ANTHEM | OTHER | 2286468 | 05 | OH | MEDICAID | 01973 | 01 | OH | PARAMOUNT | OTHER |