Provider Demographics
NPI:1790319044
Name:GRAHAM, JAMIE R
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
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 1:196 S MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-8519
Mailing Address - Country:US
Mailing Address - Phone:717-226-2968
Mailing Address - Fax:
Practice Address - Street 1:4700 UNION DEPOSIT RD STE 140
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-652-6605
Practice Address - Fax:717-652-6431
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010569367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife