Provider Demographics
NPI:1528834512
Name:GRAHAM-BICKHAM, SIMONE
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:GRAHAM-BICKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 STONEWAY CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-2407
Mailing Address - Country:US
Mailing Address - Phone:312-256-6302
Mailing Address - Fax:
Practice Address - Street 1:3404 STONEWAY CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-2407
Practice Address - Country:US
Practice Address - Phone:312-256-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula