Provider Demographics
NPI:1477201283
Name:GRAHAM, MICHELLE S
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
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:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-0552
Mailing Address - Country:US
Mailing Address - Phone:770-329-8592
Mailing Address - Fax:
Practice Address - Street 1:3981 SOPHIE PEARL LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-3547
Practice Address - Country:US
Practice Address - Phone:770-329-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider