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General NPI Number Information
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NPI Number | 1255652830
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Entity Type | Individual
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Provider Name | ROBERTA GRAHAM AGPC-NP
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Gender | Female
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 8280 MONTGOMERY RD SUIT 306
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City | CINCINNATI
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State | OH
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Zip | 45236-6101
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Country | US
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Telephone | 888-393-9799
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Fax | 937-531-7797
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Provider Business Mailing Address
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Address Line | 8280 MONTGOMERY RD SUIT 306
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City | CINCINNATI
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State | OH
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Zip | 45236-6101
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Country | US
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Telephone | 888-393-9799
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Fax | 937-531-7797
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | RN-183333-COA1
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | COA.15045-NP
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License Number State | OH
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