Provider Demographics
NPI:1861119968
Name:GRAUDIEL, VANESSA CAROLINE
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:CAROLINE
Last Name:GRAUDIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 EHLERS PL APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-2440
Mailing Address - Country:US
Mailing Address - Phone:407-552-9078
Mailing Address - Fax:
Practice Address - Street 1:7670 PARKER ST
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4247
Practice Address - Country:US
Practice Address - Phone:785-239-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist