Healthcare Provider Details

I. General information

NPI: 1093700767
Provider Name (Legal Business Name): DENISE MARIE GRAVES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

PO BOX 5520
BETHLEHEM PA
18015-0520
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5810
  • Fax: 610-954-5480
Mailing address:
  • Phone: 610-954-5810
  • Fax: 610-954-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN354580L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN354580L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number072988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: