Provider Demographics
NPI:1265088405
Name:GRAHAM, TALIA LYNNE
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:LYNNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:
Other - Last Name:CONNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:164 MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2217
Mailing Address - Country:US
Mailing Address - Phone:603-842-0350
Mailing Address - Fax:
Practice Address - Street 1:164 MILL RD
Practice Address - Street 2:
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2217
Practice Address - Country:US
Practice Address - Phone:603-842-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282570163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health