LISA MAE DIANE GRAVELINE PMHNP-BC APRN-RNP NPI 1801559984

NPI Information

NPI: 1801559984
Provider Name: LISA MAE DIANE GRAVELINE, PMHNP-BC, APRN-RNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Address:
3170 STILLWATER DR
PRESCOTT, AZ
ZIP 86305
Phone: (928) 777-3280
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Lisa Mae Diane Graveline, PMHNP-BC, APRN-RNP is a psychiatric/mental health nurse practitioner in Prescott, AZ. Lisa Mae Diane Graveline, PMHNP-BC, APRN-RNP NPI is 1801559984. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3170 STILLWATER DR
PRESCOTT, AZ
ZIP 86305-151
Phone: (928) 777-3280

The enumeration date for this NPI number is 10/15/2021 and was last updated on 10/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	RNP265685	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	RNP-265685	OTHER	ARIZONA	STATE LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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