Provider Demographics
NPI:1376867960
Name:GRAHAM, EILEEN JENNIFER ROGERS (MSN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:JENNIFER ROGERS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:JENNIFER
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, FNP-BC
Mailing Address - Street 1:11458 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-4200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11458 KINGS HWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-4200
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN88562363LF0000X
TNAPN14877363LF0000X
VA0024169532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily