Provider Demographics
NPI:1740598176
Name:GRAHAM, STEPHANIE STEPHANIE (RN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:STEPHANIE
Last Name:GRAHAM
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 1:369 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-9795
Mailing Address - Country:US
Mailing Address - Phone:740-260-9798
Mailing Address - Fax:
Practice Address - Street 1:369 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-9795
Practice Address - Country:US
Practice Address - Phone:740-260-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.240763163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse