Provider Demographics
NPI:1235911801
Name:GRAHAM, MARIANNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WEATHERED ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6642
Mailing Address - Country:US
Mailing Address - Phone:661-644-5965
Mailing Address - Fax:
Practice Address - Street 1:1106 WEATHERED ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6642
Practice Address - Country:US
Practice Address - Phone:661-644-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-17122163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant