Provider Demographics
NPI:1174833495
Name:GRAVES-WASHINGTON, LAVERNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:GRAVES-WASHINGTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W. ADAMS AVE.
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1503
Mailing Address - Country:US
Mailing Address - Phone:609-674-1651
Mailing Address - Fax:
Practice Address - Street 1:268 NORTH NEW RD.
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232
Practice Address - Country:US
Practice Address - Phone:609-646-4064
Practice Address - Fax:609-272-8526
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11508100163WW0000X
NJ26NJ00771900207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine