Healthcare Provider Details

I. General information

NPI: 1174833495
Provider Name (Legal Business Name): LAVERNE GRAVES-WASHINGTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 NORTH NEW RD.
PLEASANTVILLE NJ
08232
US

IV. Provider business mailing address

604 W. ADAMS AVE.
PLEASANTVILLE NJ
08232-1503
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-4064
  • Fax: 609-272-8526
Mailing address:
  • Phone: 609-674-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number26NO11508100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NJ00771900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00771900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: