Healthcare Provider Details

I. General information

NPI: 1225902620
Provider Name (Legal Business Name): TASHA DRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 CHANDLER DR
SPOONER WI
54801-2202
US

IV. Provider business mailing address

1280 CHANDLER DR
SPOONER WI
54801-2202
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number108845630
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: