Provider Demographics
NPI:1376129734
Name:GRAHAM, GENEVA LORETTA (CARE PROVIDER)
Entity Type:Individual
Prefix:MISS
First Name:GENEVA
Middle Name:LORETTA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 TUSSING PARK DR APT 202
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7525
Mailing Address - Country:US
Mailing Address - Phone:614-373-6338
Mailing Address - Fax:
Practice Address - Street 1:2836 TUSSING PARK DR APT 202
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7525
Practice Address - Country:US
Practice Address - Phone:513-372-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide