Provider Demographics
NPI:1205203361
Name:GRAVELY, DONNA (FNP-BC, CWON, CDE)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GRAVELY
Suffix:
Gender:F
Credentials:FNP-BC, CWON, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1929
Mailing Address - Country:US
Mailing Address - Phone:276-666-7200
Mailing Address - Fax:
Practice Address - Street 1:319 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1929
Practice Address - Country:US
Practice Address - Phone:276-666-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily