Provider Demographics
NPI:1295367183
Name:GRAVES, VANESSA LEE (CNA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78058 COUNTRY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-5036
Mailing Address - Country:US
Mailing Address - Phone:609-302-5770
Mailing Address - Fax:
Practice Address - Street 1:78058 COUNTRY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-5036
Practice Address - Country:US
Practice Address - Phone:509-302-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60887492376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide