Provider Demographics
NPI:1992005011
Name:GRAHAM, JESSICA LAUREN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:COMSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8800 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4413
Mailing Address - Country:US
Mailing Address - Phone:248-363-7500
Mailing Address - Fax:248-363-7700
Practice Address - Street 1:8800 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4413
Practice Address - Country:US
Practice Address - Phone:248-363-7500
Practice Address - Fax:248-363-7700
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily