Active NPI
Leslie Lynne Graham, LPN
- Licensed Practical Nurse
- Willowick, OH
National Provider Identifier
1619997442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN092731
- Practice address
- 696 Dickerson
Willowick, OH 44095 - Phone
- (440) 943-0391
- NPI assigned
- Jul 21, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN092731 | OH | Primary |
Addresses
Primary practice location
696 Dickerson
Willowick, OH 44095
Mailing address
2321 Green Ridge Dr.
Wickliffe, OH 44092
Phone (440) 347-9653
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2434 | Medicaid | OH | |
| 2350638 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN092731 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619997442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2321 GREEN RIDGE DR.",
"city": "WICKLIFFE",
"state": "OH",
"postal_code": "44092",
"telephone_number": "440-347-9653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "696 DICKERSON",
"city": "WILLOWICK",
"state": "OH",
"postal_code": "44095",
"telephone_number": "440-943-0391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "LESLIE",
"middle_name": "LYNNE",
"name_prefix": "Mrs.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN092731",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2434",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2350638",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willowick, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.