Mary Layne Graham, BS, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

1409 W Carroll Ave
Chicago, IL 60607-1105

Phone

(312) 733-0883

NPI assigned

Nov 19, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eyas Landing, Inc.

  • Early Intervention Provider Agency
  • Chicago, IL
  • NPI 1053621391
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1093351652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1458 N BOSWORTH AVE APT 3M",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422380",
            "telephone_number": "630-888-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 W CARROLL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606071105",
            "telephone_number": "312-733-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MARY",
        "middle_name": "LAYNE",
        "name_prefix": "Miss",
        "credential": "BS, RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kahla J Graham
• Kendra Graham, M.A. SLP
• Kristi J. Graham, PHD
• Krystle M. Graham, AGACNP-BC
• Louis S Graham, D.D.S.
• Melissa Nolasco Graham, OTR/L
• Michael Graham Jr.
• Nancy E Graham, CNM,APN
• Nathan James Graham, MD
• Nicole C Graham, ATC, LAT

• Registered Dietitian in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.