MEDICARE: SUSAN GRAVEN C.N.M., N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	NMW 1266	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN 415746	OTHER	CA	NURSING LICENSE NUMBER

General Provider Information

NPI Number	:	1255425096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN GRAVEN C.N.M., N.P.

Provider Business Mailing Address
First Line	:	1720 EL CAMINO REAL STE 120
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3225
Country	:	US
Telephone Number	:	650-697-7716
Fax Number	:	650-697-1723

Provider Business Practice Location Address
First Line	:	1720 EL CAMINO REAL STE 120
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3225
Country	:	US
Telephone Number	:	650-697-7716
Fax Number	:	650-697-1723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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