Provider Information for 1255943759
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
ERICA DANIELLE-ELLIS GRAHAM
Sex: Female
NPI: 1255943759
Last Updated: 2023-03-20
Certification Date: 2023-03-20
Certification Date: 2023-03-20
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1255943759 | ||||||||
| Enumeration Date | 2020-08-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 262 BLUEWELL AVE BLUEFIELD, WV 24701-7580 United States Phone: 918-273-8597 | Fax: | ||||||||
| Primary Practice Address | 262 BLUEWELL AVE BLUEFIELD, WV 24701-7580 United States Phone: 918-273-8597 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|