Provider Demographics
NPI:1821797358
Name:GRAHAM, BERNICE R (RN)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:R
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 1:1001 N LELAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3338
Mailing Address - Country:US
Mailing Address - Phone:765-215-3448
Mailing Address - Fax:
Practice Address - Street 1:1001 N LELAND AVE STE A
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3338
Practice Address - Country:US
Practice Address - Phone:765-215-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28123205A163WC1500X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health