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General NPI Number Information
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NPI Number | 1841552924
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Entity Type | Individual
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Provider Name | JEREMY JAYME GRAHAM RN, MSN, NP-C
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Gender | Male
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 1100 S ELISEO DR STE 1
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City | GREENBRAE
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State | CA
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Zip | 94904
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Country | US
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Telephone | 415-514-5000
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Fax | 415-502-5550
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Provider Business Mailing Address
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Address Line | 8 LOCKSLEY AVE APT 7F
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-3849
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Country | US
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Telephone | 609-674-8193
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Fax | 415-502-5550
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 829229
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR14301200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN601208
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22686
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 22686
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License Number State | CA
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