MEDICARE: ANGELIQUE CHARLENE GRAHAM HARLAN RN

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	163W00000X	Registered Nurse	241246	TN

General Provider Information

NPI Number	:	1932058278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE CHARLENE GRAHAM HARLAN RN

Provider Business Mailing Address
First Line	:	3618 WATERFORD CV S
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-8977
Country	:	US
Telephone Number	:	901-277-6970
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 WATERFORD CV S
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-8977
Country	:	US
Telephone Number	:	901-277-6970
Fax Number	:

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

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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