Individual
STACEY ANN GRAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3719
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209007192
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R03746
MEDICARE PTAN
IL
Enumeration date
08/12/2008
Last updated
05/22/2020
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