Provider Demographics
NPI:1336329689
Name:GRAHAM, BEVERLY L (BSN)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2918
Mailing Address - Country:US
Mailing Address - Phone:412-675-8581
Mailing Address - Fax:
Practice Address - Street 1:335 SHAW AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2918
Practice Address - Country:US
Practice Address - Phone:412-675-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN192170L163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult