Provider Demographics
NPI:1962861179
Name:GRAVES, MARY JO (CPNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 N HOWARD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2955
Mailing Address - Country:US
Mailing Address - Phone:559-438-4100
Mailing Address - Fax:559-447-4496
Practice Address - Street 1:7011 N HOWARD ST STE 202
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2955
Practice Address - Country:US
Practice Address - Phone:559-438-4100
Practice Address - Fax:559-447-4496
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC236057-NPF 361363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics