Provider Demographics
NPI:1831674415
Name:GRAHAM BRIGHT, JANAE (LPN)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:GRAHAM BRIGHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S GROSVENOR CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1016
Mailing Address - Country:US
Mailing Address - Phone:757-920-9120
Mailing Address - Fax:
Practice Address - Street 1:806 S GROSVENOR CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1016
Practice Address - Country:US
Practice Address - Phone:757-920-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002095995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002095995OtherLICENSE