Provider Demographics
NPI:1801611959
Name:GRAVES, DIANA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 BRENTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6226
Mailing Address - Country:US
Mailing Address - Phone:408-472-6648
Mailing Address - Fax:
Practice Address - Street 1:1855 PLUMAS ST STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3385
Practice Address - Country:US
Practice Address - Phone:775-843-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV823041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily