Provider Demographics
NPI:1194114454
Name:GRAHAM, JASON CHRISTOPHER (APN-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ROUTE ROUTE 47 SOUTH
Mailing Address - Street 2:UNIT WU-N - 2ND FLOOR
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1416
Mailing Address - Country:US
Mailing Address - Phone:609-451-1125
Mailing Address - Fax:609-438-7944
Practice Address - Street 1:1304 ROUTE ROUTE 47 SOUTH
Practice Address - Street 2:UNIT WU-N - 2ND FLOOR
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1416
Practice Address - Country:US
Practice Address - Phone:609-451-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00877100363LF0000X
NJ26NR09497300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty