Individual
JENNIFER GRAVENISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
3201 1ST ST, EMMETSBURG, IA 50536-2516
(712) 221-0684
Mailing address
930 W BLUFF ST, CHEROKEE, IA 51012-1531
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
141312
IA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G166054
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141312
REGISTERED NURSE
IA
01
—
G166054
PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER
IA
Enumeration date
07/08/2021
Last updated
12/20/2022
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