Individual
LISA MARIE GRAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5063 S COTTONWOOD ST, SALT LAKE CITY, UT 84107-6766
(801) 507-1800
(801) 507-1825
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5640031-1205
UT
Other
Enumeration date
07/04/2006
Last updated
09/24/2025
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