Provider Demographics
NPI:1366615106
Name:GRAHAM, JENNIFER L (RN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 N HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:KS
Mailing Address - Zip Code:67111-8924
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:316-681-5599
Practice Address - Street 1:2660 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURDOCK
Practice Address - State:KS
Practice Address - Zip Code:67111-8924
Practice Address - Country:US
Practice Address - Phone:316-651-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-80009-062163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine