Provider Demographics
NPI:1700427903
Name:GRAHAM, CLEOPATRA (LPN)
Entity Type:Individual
Prefix:
First Name:CLEOPATRA
Middle Name:
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 1:9832 57TH AVE APT 17N
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4941
Mailing Address - Country:US
Mailing Address - Phone:718-592-0021
Mailing Address - Fax:
Practice Address - Street 1:9832 57TH AVE APT 17N
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4941
Practice Address - Country:US
Practice Address - Phone:718-592-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267510-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse