Provider Demographics
NPI:1669725156
Name:GRAHAM, WILLIEMAE PATRICIA (STNA)
Entity type:Individual
Prefix:
First Name:WILLIEMAE
Middle Name:PATRICIA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 WOODBROOK CIR W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3192
Mailing Address - Country:US
Mailing Address - Phone:614-749-3593
Mailing Address - Fax:
Practice Address - Street 1:1268 WOODBROOK CIR W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3192
Practice Address - Country:US
Practice Address - Phone:614-749-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH323038530800376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH323038530800OtherSTATE TESTED NURSING ASSITANT