Healthcare Provider Details

I. General information

NPI: 1376756783
Provider Name (Legal Business Name): CYNTHIA ANN GRAVES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 OLYMPIC ST
SPRINGFIELD OR
97477-3413
US

IV. Provider business mailing address

3150 ADMIRAL ST
EUGENE OR
97404-1718
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3550
  • Fax:
Mailing address:
  • Phone: 541-688-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number200342037RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number200342037RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: