Healthcare Provider Details

I. General information

NPI: 1275354326
Provider Name (Legal Business Name): JUDITH LYNN GRAFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

IV. Provider business mailing address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

V. Phone/Fax

Practice location:
  • Phone: 410-293-1323
  • Fax: 410-293-2465
Mailing address:
  • Phone: 410-293-1323
  • Fax: 410-293-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR127454
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR127454
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberR127454
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberR127454
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: