Provider Demographics
NPI:1720431935
Name:GRAHAM, MICHELE (RN,BSN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 MILL SPRINGS PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2615
Mailing Address - Country:US
Mailing Address - Phone:817-443-8775
Mailing Address - Fax:
Practice Address - Street 1:165 THORNDIKE ST APT 513
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-3489
Practice Address - Country:US
Practice Address - Phone:817-443-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX844153163WA2000X, 163WC0400X, 163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health