Individual
LEAH GRAVESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
311 S OTTER CREEK RD, STREATOR, IL 61364-3117
(815) 257-5324
Mailing address
106 KAREN DR, DWIGHT, IL 60420-1600
(815) 257-5324
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209020593
IL
Other
Enumeration date
12/11/2019
Last updated
01/24/2022
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