Provider Demographics
NPI:1700063245
Name:HARGRAVES-SHAW, YOLANDA DENISE (CRNA)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:DENISE
Last Name:HARGRAVES-SHAW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:DENISE
Other - Last Name:HARGRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:4568 COGNAC CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7803
Mailing Address - Country:US
Mailing Address - Phone:901-362-5814
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT VINCENT CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5423
Practice Address - Country:US
Practice Address - Phone:501-552-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226155367500000X
TN158813163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care