Provider Demographics
NPI:1780429910
Name:GRAVELLE, MEGAN (DNP/FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GRAVELLE
Suffix:
Gender:F
Credentials:DNP/FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4332
Mailing Address - Country:US
Mailing Address - Phone:218-348-7780
Mailing Address - Fax:
Practice Address - Street 1:400 E 3RD ST BLDG F
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily