Brenda Lee Graham

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704218257 Issued in MI

Practice address

7751 Byron Center Ave SW
Suite C
Byron Center, MI 49315-8001

Phone

(616) 267-7668

NPI assigned

Jan 25, 2006

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

Nurse Practitioner

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.

• Ausable Valley CMH

  • Clinic/Center
  • Tawas City, MI
  • NPI 1952628893
  NPD (past)
• Geriatric Physician Staffing, P. C.

  • Geriatric Medicine (Family Medicine) Physician
  • Traverse City, MI
  • NPI 1215989868
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408320000000",
    "number": "1114997624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7751 BYRON CENTER AVE SW",
            "address_2": "SUITE C",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493158001",
            "telephone_number": "616-267-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "BRENDA",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2014-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704218257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McKenzie Gibson
• Stephen Eric Gillich, RPH
• Stacy Walton Goldsholl, MD
• Rebecca Gomez de Tuinstra, PHD
• Good Samaritans Medical Transport LLC
• Grand Rapids Counseling and Consultation
• Grand Rapids Counseling and Consultation LLC
• Ruth Gray
• Rachel Blair Grigoryan, LMSW
• Naomi Beth Grimm

• Gerontology Nurse Practitioner in Byron Center, MI
• Providers in Byron Center, MI by specialty
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; 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.