Provider Demographics
NPI:1831552710
Name:GRAHAM, D. MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:D. MICHELLE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-1316
Mailing Address - Country:US
Mailing Address - Phone:607-382-4023
Mailing Address - Fax:
Practice Address - Street 1:9579 VOCATIONAL DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9043
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:607-795-5304
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse