Provider Demographics
NPI:1942076732
Name:GRAHAM, CHRISTIAN (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 NORTHLAND PL NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3943
Mailing Address - Country:US
Mailing Address - Phone:651-408-3979
Mailing Address - Fax:
Practice Address - Street 1:808 NORTHLAND PL NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3943
Practice Address - Country:US
Practice Address - Phone:651-408-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2510885163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health