Provider Demographics
NPI:1124216890
Name:CRAVANAS, KEESHA (CNS)
Entity Type:Individual
Prefix:
First Name:KEESHA
Middle Name:
Last Name:CRAVANAS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2608
Mailing Address - Country:US
Mailing Address - Phone:510-302-3790
Mailing Address - Fax:510-272-0209
Practice Address - Street 1:700 ADELINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2608
Practice Address - Country:US
Practice Address - Phone:510-302-3790
Practice Address - Fax:510-272-0209
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2774364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist