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General NPI Number Information
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NPI Number | 1700489093
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Entity Type | Individual
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Provider Name | ABBEY MARIE GRAVES PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1200 S YORK ST STE 2000
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City | ELMHURST
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State | IL
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Zip | 60126-5634
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Country | US
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Telephone | 331-221-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 WINFIELD RD FL 3
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City | WARRENVILLE
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State | IL
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Zip | 60555-4025
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085007920
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License Number State | IL
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