Individual
LAVONNA SUE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
130 GEORGE ST, BECKLEY, WV 25801-2648
(304) 929-2669
Mailing address
PO BOX 585, FAIRDALE, WV 25839-0585
(304) 894-2345
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
76652
WV
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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