Provider Demographics
NPI:1134715139
Name:GRAVES, DEBORAH A
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
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 1:5746 SAINT ELMO AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-3020
Mailing Address - Country:US
Mailing Address - Phone:513-203-2827
Mailing Address - Fax:
Practice Address - Street 1:5746 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3020
Practice Address - Country:US
Practice Address - Phone:513-203-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0080625172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker