Provider Demographics
NPI:1568741296
Name:GRAVES, DEIDRE A (LPN)
Entity Type:Individual
Prefix:MISS
First Name:DEIDRE
Middle Name:A
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2448
Mailing Address - Country:US
Mailing Address - Phone:614-537-6358
Mailing Address - Fax:
Practice Address - Street 1:2159 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2448
Practice Address - Country:US
Practice Address - Phone:614-537-6358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse