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NPI Code Detail

MEDICARE: MADELINE NOELLE GRAHAM FNP

MEDICARE: MADELINE NOELLE GRAHAM FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0036794OH

General Provider Information

NPI Number : 1003664863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE NOELLE GRAHAM FNP
Provider Business Mailing Address
First Line : 209 N CHILLICOTHE ST
Second Line :
City : PLAIN CITY
State : OH
Zip : 43064-1045
Country : US
Telephone Number : 614-873-6700
Fax Number :
Provider Business Practice Location Address
First Line : 209 N CHILLICOTHE ST
Second Line :
City : PLAIN CITY
State : OH
Zip : 43064-1045
Country : US
Telephone Number : 614-873-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 07/24/2024

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