Individual
TIFFANY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18 SYLVESTER DR, WINFIELD, WV 25213-9361
(304) 395-5085
Mailing address
5187 US ROUTE 60 STE 13, HUNTINGTON, WV 25705-2076
(304) 733-5010
(304) 733-5024
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
71148
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163W00000X
—
WV
Enumeration date
09/21/2022
Last updated
09/21/2022
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