MEDICARE: TRASHASANS Y GRAVES REGISTERED NURSE

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	163WG0000X	General Practice Registered Nurse	R0066271	OK

General Provider Information

NPI Number	:	1710735592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRASHASANS Y GRAVES REGISTERED NURSE

Provider Business Mailing Address
First Line	:	2637 NW 25TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2223
Country	:	US
Telephone Number	:	495-675-9413
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 NW 25TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2223
Country	:	US
Telephone Number	:	405-675-9413
Fax Number	:

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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