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General NPI Number Information
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NPI Number | 1588105365
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Entity Type | Individual
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Provider Name | CAROL JANE GRAVES
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Gender | Female
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 4 E 6TH ST
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City | ATLANTIC
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State | IA
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Zip | 50022-1566
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Country | US
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Telephone | 712-792-4368
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Fax |
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Provider Business Mailing Address
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Address Line | 5505 UNIVERSITY AVE
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City | DES MOINES
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State | IA
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Zip | 50311-2237
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Country | US
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Telephone | 540-500-8100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A068580
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A068580
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License Number State | IA
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