Provider Demographics
NPI:1952611832
Name:GRAVES, GEORGIA ANN (RN)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5683
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-5683
Mailing Address - Country:US
Mailing Address - Phone:760-803-2144
Mailing Address - Fax:
Practice Address - Street 1:419 CALLE CORAZON
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-8528
Practice Address - Country:US
Practice Address - Phone:760-721-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207732163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health