Individual
JENNIFER ELIZABETH GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
970 EAST WASHINGTON STREET, MEDINA, OH 44256
(330) 723-7999
Mailing address
6711 W SMITH RD, MEDINA, OH 44256-7510
(330) 591-5060
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
COA. 1611-NP
OH
363LP2300X
Primary Care Nurse Practitioner
Primary
COA. 1611-NP
OH
Other
Enumeration date
06/30/2014
Last updated
06/30/2014
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