Provider Demographics
NPI:1093700767
Name:GRAVES, DENISE MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5520
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-0520
Mailing Address - Country:US
Mailing Address - Phone:610-954-5810
Mailing Address - Fax:610-954-5480
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:610-954-5810
Practice Address - Fax:610-954-5480
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN354580L163W00000X, 367500000X
PA072988367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1584019OtherGATEWAY
PA2001184OtherKHP CENTRAL
PA2350206000OtherINDEP. BLUE CROSS
PA1675564OtherFIRST PRIORITY
PA50044074OtherCAPITAL ADVANTAGE
PA1027806650001Medicaid
PA90778OtherGEISINGER
PA9204472OtherAETNA
PA11803021OtherCAQH
PA1675564OtherHIGHMARK
PA9204472OtherAETNA
PA11803021OtherCAQH
PA1584019OtherGATEWAY