MEDICARE: NICHELLE GRAFFENREED STNA

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	374U00000X	Home Health Aide	401144200910	OH

General Provider Information

NPI Number	:	1548771405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHELLE GRAFFENREED STNA

Provider Business Mailing Address
First Line	:	4660 E 94TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1346
Country	:	US
Telephone Number	:	216-630-7663
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 E 94TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1346
Country	:	US
Telephone Number	:	216-630-7663
Fax Number	:

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

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	06/16/2018

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