Provider Demographics
NPI:1134519705
Name:GRAHAM, LAURA LOUISE (LPN)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LOUISE
Last Name:GRAHAM
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 1:11557 US HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9690
Mailing Address - Country:US
Mailing Address - Phone:937-695-0959
Mailing Address - Fax:937-695-0303
Practice Address - Street 1:11557 US HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-9690
Practice Address - Country:US
Practice Address - Phone:937-695-0959
Practice Address - Fax:937-695-0303
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse