Healthcare Provider Details

I. General information

NPI: 1528419439
Provider Name (Legal Business Name): GRAHAM PIERCE HARBISON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EOFF ST
WHEELING WV
26003-3823
US

IV. Provider business mailing address

2000 EOFF ST
WHEELING WV
26003-3823
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-0123
  • Fax:
Mailing address:
  • Phone: 304-234-8663
  • Fax: 304-234-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number93797
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA19209NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: