Individual
MR. LUCAS ALAN GRAVELYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6435 W JEFFERSON BLVD # 434, FORT WAYNE, IN 46804-6203
(260) 436-7875
(260) 432-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-0001
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28270719A
IN
367500000X
Certified Registered Nurse Anesthetist
4704255424
MI
Other
Enumeration date
12/23/2011
Last updated
11/03/2025
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