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Individual

MRS. KIM ELAINE GRAVES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 293-8228
(937) 293-8229
Mailing address
PO BOX 932759, CLEVELAND, OH 44193-0015
(937) 293-8228
(937) 293-8229

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
COA10992NP
OH
363LA2100X
Acute Care Nurse Practitioner
COA10992NP
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.11519
OH
367500000X
Certified Registered Nurse Anesthetist
COA11519NA
OH

Other

Enumeration date
10/12/2009
Last updated
09/01/2020
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