Provider Demographics
NPI:1578866950
Name:GREAVES, JOSCELYN L (CNP)
Entity Type:Individual
Prefix:
First Name:JOSCELYN
Middle Name:L
Last Name:GREAVES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3506
Mailing Address - Country:US
Mailing Address - Phone:330-455-5011
Mailing Address - Fax:330-588-7127
Practice Address - Street 1:2726 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3506
Practice Address - Country:US
Practice Address - Phone:330-455-5011
Practice Address - Fax:330-588-7127
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP11660363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3110458Medicaid
OHNP39941Medicare PIN