Provider Demographics
NPI:1700945904
Name:GRAVES, NAKIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NAKIA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 GROSVENOR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2315
Mailing Address - Country:US
Mailing Address - Phone:216-254-7906
Mailing Address - Fax:
Practice Address - Street 1:3945 GROSVENOR RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44118-2315
Practice Address - Country:US
Practice Address - Phone:216-254-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-100652164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2215730Medicaid