Provider Demographics
NPI:1982078630
Name:GRAHAM, JANET JOANNE (LPN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:JOANNE
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 1:1510 S MILLS AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4239
Mailing Address - Country:US
Mailing Address - Phone:360-798-6153
Mailing Address - Fax:
Practice Address - Street 1:23500 KASSON ROAD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304
Practice Address - Country:US
Practice Address - Phone:916-282-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60325605164W00000X
OR201130110LPN164W00000X
CAVN259361164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse