Healthcare Provider Details

I. General information

NPI: 1861541112
Provider Name (Legal Business Name): FRANCES ROBIN GRAHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCES ROBIN RILEY FNP-C

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 W CORTARO FARMS RD #77
TUCSON AZ
85742-1200
US

IV. Provider business mailing address

2670 DIABLO DRIVE,
LAKE HAVASU CITY AZ
86406
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-7430
  • Fax: 423-884-3277
Mailing address:
  • Phone: 928-855-6071
  • Fax: 423-884-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12353
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN2594
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN142995
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: