Individual
MS. JORDAN H GRAUSTARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 PILLSBURY ST, CONCENTRA, CONCORD, NH 03301-3556
(603) 223-2300
Mailing address
5080 SPECTRUM DR, ADDISON, TX 75001-4648
(972) 720-7772
(214) 775-4502
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0204P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30331233
—
NH
05
—
3081765
—
NH
Enumeration date
06/03/2006
Last updated
08/06/2015
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