Healthcare Provider Details

I. General information

NPI: 1649473620
Provider Name (Legal Business Name): CONNIE DOREEN SCOTT-GRAHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 10TH ST
TUCSON AZ
85719
US

IV. Provider business mailing address

PO BOX 85112
TUCSON AL
85754
US

V. Phone/Fax

Practice location:
  • Phone: 520-225-3284
  • Fax:
Mailing address:
  • Phone: 520-225-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN077698
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: