Healthcare Provider Details

I. General information

NPI: 1417279571
Provider Name (Legal Business Name): ALLISON ANDREA GRAVES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

PO BOX 6591
COLUMBUS GA
31917-6591
US

V. Phone/Fax

Practice location:
  • Phone: 011499662834719
  • Fax: 011499662834721
Mailing address:
  • Phone: 706-610-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN067108
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: