Healthcare Provider Details

I. General information

NPI: 1275638454
Provider Name (Legal Business Name): ELIZABETH BRADLEY GRAHAM RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE MAIL CODE 1-111
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

9030 E BERKSHIRE PL
TUCSON AZ
85710-3015
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-1860
Mailing address:
  • Phone: 520-721-2139
  • Fax: 520-629-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberRN030054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: