Healthcare Provider Details

I. General information

NPI: 1457739310
Provider Name (Legal Business Name): DAVID GRAHAM APRN, AG-ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MARKET ST
AKRON OH
44308-2015
US

IV. Provider business mailing address

200 E MARKET ST
AKRON OH
44308-2015
US

V. Phone/Fax

Practice location:
  • Phone: 330-761-7500
  • Fax:
Mailing address:
  • Phone: 330-761-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number357112
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0029551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: