Individual
MRS. AMANDA JO GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MSN
Contact information
Practice address
43520 DIVISION ST, LANCASTER, CA 93535-4089
(661) 266-4783
Mailing address
43520 DIVISION ST, LANCASTER, CA 93535-4089
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95050649
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
11/22/2022
Last updated
11/22/2022
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