Provider Demographics
NPI:1548612682
Name:GRAHAM, CAROLYN (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4672 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:OH
Mailing Address - Zip Code:44214-9750
Mailing Address - Country:US
Mailing Address - Phone:330-464-1390
Mailing Address - Fax:
Practice Address - Street 1:1900 AKRON RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2518
Practice Address - Country:US
Practice Address - Phone:330-264-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0316688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0180416Medicaid