Provider Demographics
NPI:1275818882
Name:GRAVES, LESLIE ERIN (RD/LD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ERIN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KNOXBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7620
Mailing Address - Country:US
Mailing Address - Phone:785-538-9326
Mailing Address - Fax:
Practice Address - Street 1:305 FORT RILEY BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6357
Practice Address - Country:US
Practice Address - Phone:785-538-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1655133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered