Individual
MR. OLIVER LOUIS DE GRAVELLE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
02915
LA
363LN0000X
Neonatal Nurse Practitioner
Primary
5015451
NC
363LN0000X
Neonatal Nurse Practitioner
AP02915
LA
Other
Enumeration date
07/18/2007
Last updated
06/02/2022
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