Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 308690 | LA |
NPI | 1003202581 |
---|---|
Provider Name | Stephanie Michele Graebert |
First Address | Metairie, LA 70006-2935 |
Second Address | Metairie, LA 70006-2935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 20/09/2018 |