Provider Demographics
NPI:1376319863
Name:GRAHAM, IEESHIA JANAY
Entity Type:Individual
Prefix:
First Name:IEESHIA
Middle Name:JANAY
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 20TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1343
Mailing Address - Country:US
Mailing Address - Phone:330-322-3513
Mailing Address - Fax:
Practice Address - Street 1:1634 20TH ST APT 6
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1343
Practice Address - Country:US
Practice Address - Phone:330-322-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide