Graveline, Lisa Mae Diane

Graveline, Lisa Mae Diane is an individual health care provider with primary practice located at 3274 Bob Dr , Prescott Valley AZ 86314-8640. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Graveline, Lisa Mae Diane can be contacted via phone (928) 203-5414.

Contact Information

Primary practice address
3274 Bob Dr Prescott Valley AZ 86314-8640
Phone: (928) 203-5414
Fax: (866) 984-3891
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X RNP265685 Arizona

Profile Details

NPI number 1801559984
LBN Legal business name Graveline, Lisa Mae Diane
Credentials PMHNP-BC, APRN-RNP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 15th, 2021
Last updated Mar 13th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801559984 NPPES
Arizona Other RNP-265685 STATE LICENSE NUMBER

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