Provider Demographics
NPI:1982292538
Name:GRAHAM-SAMUELS, BARBARA ICYLIN (RN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ICYLIN
Last Name:GRAHAM-SAMUELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:ICYLIN
Other - Last Name:GRAHAM-SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BARBARA GRAHAM
Mailing Address - Street 1:202 LA COSTA LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1486
Mailing Address - Country:US
Mailing Address - Phone:954-815-2575
Mailing Address - Fax:
Practice Address - Street 1:202 LA COSTA LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1486
Practice Address - Country:US
Practice Address - Phone:954-815-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9163740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse