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Individual

LEVI GRAVES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
415 N 3RD AVE STE B, POCATELLO, ID 83201-6306
(208) 646-4165
Mailing address
226 W CARTER ST, POCATELLO, ID 83204-3454
(208) 252-5451

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
77238
ID

Other

Enumeration date
08/28/2023
Last updated
08/28/2023
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