Individual
INDICA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
202 E BAGLEY RD, BEREA, OH 44017-2058
(440) 234-0006
Mailing address
343 W BAGLEY RD, BEREA, OH 44017-1370
(440) 260-6835
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.179472.MEDS-IV
OH
Other
Enumeration date
08/13/2024
Last updated
08/13/2024
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