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Individual

CARLA JEAN GRAHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2197
(757) 953-5000
Mailing address
2211 SHIPS XING, CHESAPEAKE, VA 23323-4028
(260) 273-5923

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28164485A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71012726A
IN

Other

Enumeration date
03/19/2020
Last updated
07/15/2022
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