MEDICARE: VALERIE GRAVATTE

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	372600000X	Adult Companion		NV
2	3747A0650X	Attendant Care Provider	H1400259	NV
3	376J00000X	Homemaker		NV
4	3747P1801X	Personal Care Attendant		NV
5	372500000X	Chore Provider		NV

General Provider Information

NPI Number	:	1154821569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE GRAVATTE

Provider Business Mailing Address
First Line	:	5045 HARRISON DR APT 147
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1088
Country	:	US
Telephone Number	:	725-500-4615
Fax Number	:

Provider Business Practice Location Address
First Line	:	5045 HARRISON DR APT 147
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1088
Country	:	US
Telephone Number	:	725-500-4615
Fax Number	:

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

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	02/13/2018

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Directions to “ VALERIE GRAVATTE ” Practice Location

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