Healthcare Provider Details

I. General information

NPI: 1760410419
Provider Name (Legal Business Name): GEORGE EDWARD GRAVES CRNA07
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH-HITCHCOCK CLINIC
LEBANON NH
03756-1000
US

IV. Provider business mailing address

74 BUTTERNUT RD
NORWICH VT
05055-9790
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 802-649-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number036510-23-11
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: