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Individual

BETHANY ANNE GRAHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
1250 RALSTON AVE, SUITE 204, DEFIANCE, OH 43512-5311
(419) 782-8332
(419) 782-6855
Mailing address
1250 RALSTON AVE, SUITE 204, DEFIANCE, OH 43512-5311
(419) 782-8332
(419) 782-6855

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP11740
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3093558
OH
01
GRNP37611
MEDICARE
OH
Enumeration date
09/08/2010
Last updated
11/03/2023
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