Provider Demographics
NPI:1942881248
Name:GRAVES, MELISSA MARGARET
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGARET
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W SOUTHFIELD BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1484
Mailing Address - Country:US
Mailing Address - Phone:414-510-1259
Mailing Address - Fax:
Practice Address - Street 1:1321 W SOUTHFIELD BLVD APT 104
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1484
Practice Address - Country:US
Practice Address - Phone:414-510-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229335163W00000X
WI11236367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse