Provider Demographics
NPI:1760049670
Name:RAVEN, ARTHUR L JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:L
Last Name:RAVEN
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3603
Mailing Address - Country:US
Mailing Address - Phone:229-942-3186
Mailing Address - Fax:
Practice Address - Street 1:205 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3603
Practice Address - Country:US
Practice Address - Phone:229-942-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN093253164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty