MEDICARE: STEPHANIE JL GRAHAM RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN726545	PA

General Provider Information

NPI Number	:	1396612511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JL GRAHAM RN

Provider Business Mailing Address
First Line	:	765 LIBERTY ST STE 105
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2567
Country	:	US
Telephone Number	:	814-373-2310
Fax Number	:	814-373-2313

Provider Business Practice Location Address
First Line	:	765 LIBERTY ST STE 105
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2567
Country	:	US
Telephone Number	:	814-373-2310
Fax Number	:	814-373-2313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	10/22/2025

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