Provider Demographics
NPI:1033104559
Name:GRAVES, SUSAN NORTON
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NORTON
Last Name:GRAVES
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 1:4915 BAYMEADOWS RD
Mailing Address - Street 2:#3-G
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4731
Mailing Address - Country:US
Mailing Address - Phone:904-730-8770
Mailing Address - Fax:904-730-8770
Practice Address - Street 1:4915 BAYMEADOWS RD
Practice Address - Street 2:#3-G
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4731
Practice Address - Country:US
Practice Address - Phone:904-730-8770
Practice Address - Fax:904-730-8770
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist