Individual
MS. MARY K GRAVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1421 N STATE ST, SUITE 203, JACKSON, MS 39202-1658
(601) 355-1234
Mailing address
1421 N STATE ST, SUITE 203, JACKSON, MS 39202-1658
(601) 355-1234
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R526401
MS
367500000X
Certified Registered Nurse Anesthetist
TAP1958
LA
Other
Enumeration date
11/20/2008
Last updated
04/29/2015
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