Provider Demographics
NPI:1417614553
Name:GRAHAM DOSUMU, LATOYA (RN)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:GRAHAM DOSUMU
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 1:8224 TIERRA DEL SOL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5713
Mailing Address - Country:US
Mailing Address - Phone:817-770-9601
Mailing Address - Fax:
Practice Address - Street 1:8224 TIERRA DEL SOL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-5713
Practice Address - Country:US
Practice Address - Phone:682-999-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX824602163WC0400X, 163WC1500X, 163WH0200X, 163WM1400X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)