Individual
TYNNETTA GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1000 CATHEDRAL ST, BALTIMORE, MD 21201-5418
(410) 396-1295
Mailing address
PO BOX 64888, BALTIMORE, MD 21264-4888
(301) 631-8101
(301) 631-1002
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R153464
MD
363LF0000X
Family Nurse Practitioner
Primary
R153464
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
406596000
—
MD
Enumeration date
08/09/2006
Last updated
04/18/2019
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