Provider Demographics
NPI:1053407007
Name:GRAVES, JANET DIANE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:DIANE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 COASTAL VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9038
Mailing Address - Country:US
Mailing Address - Phone:585-545-4638
Mailing Address - Fax:
Practice Address - Street 1:384 COASTAL VIEW DR.
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9038
Practice Address - Country:US
Practice Address - Phone:585-545-4638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241886-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered