Provider Demographics
NPI:1033496757
Name:GRAVES, ELLEN GERMAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:GERMAINE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 N STONEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9332
Mailing Address - Country:US
Mailing Address - Phone:734-384-8713
Mailing Address - Fax:
Practice Address - Street 1:4965 N STONEY CREEK RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9332
Practice Address - Country:US
Practice Address - Phone:734-384-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704112024163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health