Provider Demographics
NPI:1386988392
Name:GRAHAM, SHANNON JANELLE (MSN, ANP-C)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:JANELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MSN, ANP-C
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:JANELLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:04276 HOSPITAL SOUTH BOX 3677
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY MEDICAL CENTER 2301 ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC184446163W00000X
NC5005969363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse