Provider Demographics
NPI:1003947086
Name:GRAHAM, CLEO D (RNP)
Entity Type:Individual
Prefix:MRS
First Name:CLEO
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HOWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3054
Mailing Address - Country:US
Mailing Address - Phone:401-438-6609
Mailing Address - Fax:
Practice Address - Street 1:111 HOWLAND AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3054
Practice Address - Country:US
Practice Address - Phone:401-438-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP23079163WD0400X
RIRN23079163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22916-4OtherBLUE CROSS BLUE SHIELD
RI410545OtherBLUE CHIP
RI28451OtherNEIGHBORHOOD HEALTH PLAN