Provider Demographics
NPI:1518766658
Name:GRAHAM, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E 6TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:NE
Mailing Address - Zip Code:68020-2230
Mailing Address - Country:US
Mailing Address - Phone:402-719-3332
Mailing Address - Fax:
Practice Address - Street 1:302 E 6TH ST APT 7
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:NE
Practice Address - Zip Code:68020-2230
Practice Address - Country:US
Practice Address - Phone:402-719-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant