Healthcare Provider Details

I. General information

NPI: 1619468329
Provider Name (Legal Business Name): JANE VIOLA GRAHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 COLESVILLE RD
SILVER SPRING MD
20901-2429
US

IV. Provider business mailing address

10225 COLESVILLE RD
SILVER SPRING MD
20901-2429
US

V. Phone/Fax

Practice location:
  • Phone: 240-918-2317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN45884
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: