Provider Demographics
NPI:1942303524
Name:GRAVES, ELISE (MEDICAL LAB TECH)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MEDICAL LAB TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 SW 187TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:971-227-3783
Mailing Address - Fax:503-649-6503
Practice Address - Street 1:2452 SW 187TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:971-227-3783
Practice Address - Fax:503-649-6503
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other