MEDICARE: NATORI GRAVITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703122744	MI

General Provider Information

NPI Number	:	1033926365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATORI GRAVITT

Provider Business Mailing Address
First Line	:	1756 CAMPAU FARMS CIR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-5163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 CAMPAU FARMS CIR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-5163
Country	:	US
Telephone Number	:	313-680-0421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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