Provider Demographics
NPI:1336490846
Name:GRAHAM, VENUS YVONNE (RN)
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:YVONNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16950 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4331
Mailing Address - Country:US
Mailing Address - Phone:313-523-9164
Mailing Address - Fax:
Practice Address - Street 1:16950 MARTIN RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4331
Practice Address - Country:US
Practice Address - Phone:313-523-9164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704207747163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704207747OtherNURSING LICIENCE