Healthcare Provider Details

I. General information

NPI: 1619776903
Provider Name (Legal Business Name): TY GRAHAM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 HEATH TRCE
CANAL WINCHESTER OH
43110-7706
US

IV. Provider business mailing address

3524 HEATH TRCE
CANAL WINCHESTER OH
43110-7706
US

V. Phone/Fax

Practice location:
  • Phone: 419-371-3740
  • Fax:
Mailing address:
  • Phone: 614-398-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.155456.MEDS
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: