MEDICARE: RENEE ANN GRAHAM FNP-C

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
1	363LF0000X	Family Nurse Practitioner	R121509	MD

General Provider Information

NPI Number	:	1891481149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ANN GRAHAM FNP-C

Provider Business Mailing Address
First Line	:	1010 BITTINGER RD
Second Line	:
City	:	SWANTON
State	:	MD
Zip	:	21561-2100
Country	:	US
Telephone Number	:	240-321-4712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 BITTINGER RD
Second Line	:
City	:	SWANTON
State	:	MD
Zip	:	21561-2100
Country	:	US
Telephone Number	:	240-321-4712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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