Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | MD2014-0937 | NM |
N | 207RN0300X | Nephrologist | 48168 | CO |
N | 207RN0300X | Nephrologist | MD2014-0937 | NM |
NPI | 1316069727 |
---|---|
Provider Name | Jennifer De Graauw |
First Address | Wheat Ridge, CO 80033-6713 |
Second Address | Albuquerque, NM 87110-7644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 16/08/2021 |