Healthcare Provider Details

I. General information

NPI: 1831170505
Provider Name (Legal Business Name): SUSAN DRAVES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N WABASH AVE STE 370
MARION IN
46952-2600
US

IV. Provider business mailing address

330 NORTH WABASH AVENUE SUITE G20
MARION IN
46952-2600
US

V. Phone/Fax

Practice location:
  • Phone: 765-660-7630
  • Fax: 765-664-3895
Mailing address:
  • Phone: 765-660-7600
  • Fax: 765-651-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000254A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: