MEDICARE: DIANA GAIL GRAVES

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1700418209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GAIL GRAVES

Provider Business Mailing Address
First Line	:	8322 66TH AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-8404
Country	:	US
Telephone Number	:	971-219-4479
Fax Number	:

Provider Business Practice Location Address
First Line	:	8322 66TH AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-8404
Country	:	US
Telephone Number	:	971-219-4479
Fax Number	:

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

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	02/12/2020

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Directions to “ DIANA GAIL GRAVES ” Practice Location

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