Provider Demographics
NPI:1942727797
Name:GRAHAM, LANI (NP)
Entity type:Individual
Prefix:
First Name:LANI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:
Other - Last Name:WEINTRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1239 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5947
Mailing Address - Country:US
Mailing Address - Phone:631-741-6565
Mailing Address - Fax:631-828-4545
Practice Address - Street 1:1050 OLD NICHOLS RD
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5026
Practice Address - Country:US
Practice Address - Phone:631-828-4545
Practice Address - Fax:631-828-4545
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308386363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health