Provider Demographics
NPI:1659139178
Name:GRAHAM, JES ANSLEY (DOULA)
Entity Type:Individual
Prefix:
First Name:JES
Middle Name:ANSLEY
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7119
Mailing Address - Country:US
Mailing Address - Phone:571-409-3524
Mailing Address - Fax:
Practice Address - Street 1:8419 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7119
Practice Address - Country:US
Practice Address - Phone:571-409-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula