Provider Demographics
NPI:1841552924
Name:GRAHAM, JEREMY JAYME (RN, MSN, NP-C)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JAYME
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RN, MSN, NP-C
Other - Prefix:
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Mailing Address - Street 1:8 LOCKSLEY AVE APT 7F
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3849
Mailing Address - Country:US
Mailing Address - Phone:609-674-8193
Mailing Address - Fax:415-502-5550
Practice Address - Street 1:1100 S ELISEO DR STE 1
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-514-5000
Practice Address - Fax:415-502-5550
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2018-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA829229163W00000X
NJ26NR14301200163W00000X
PARN601208163W00000X
CA22686363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily