Provider Demographics
NPI:1295574259
Name:GRAHAM, GENNIFER MICHELLE
Entity type:Individual
Prefix:
First Name:GENNIFER
Middle Name:MICHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18602 DEL RIO PL UNIT A
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9122
Mailing Address - Country:US
Mailing Address - Phone:818-970-6996
Mailing Address - Fax:
Practice Address - Street 1:18602 DEL RIO PL UNIT A
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9122
Practice Address - Country:US
Practice Address - Phone:818-970-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula