| Doctor Name: | MARY JEAN DEGRAVE |
| NPI Number: | 1255735494 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 4704236417 |
| Business Practice Address: | 1721 S Stephenson Ave Iron Mountain, MI - 498013637 |
| Business Phone Number: | 9067741313 |
| Business Fax Number: | |
| Mailing Address: | E21892 Crooked Lake Rd, WATERSMEET |
| State: | MI |
| Postal Code: | 499699740 |
| Phone Number: | 9062852605 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2014 |
| NPI Last Update Date: | 10/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704236417 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |