Individual
LISA MAE DIANE GRAVELINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, APRN-RNP
Contact information
Practice address
3274 BOB DR, PRESCOTT VALLEY, AZ 86314-8640
(928) 203-5414
(866) 984-3891
Mailing address
3274 BOB DR, PRESCOTT VALLEY, AZ 86314-8640
(928) 203-5414
(866) 984-3891
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RNP265685
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RNP-265685
STATE LICENSE NUMBER
AZ
Enumeration date
10/15/2021
Last updated
03/13/2024
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