Healthcare Provider Details

I. General information

NPI: 1790757623
Provider Name (Legal Business Name): DEBRA JEANNE GRAHAM DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA JEANNE WRIGHT CPNP

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4537 COLLEGE AVE
SAN DIEGO CA
92115-4010
US

IV. Provider business mailing address

PO BOX 1770
LA MESA CA
91944-1770
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-1895
  • Fax: 619-229-1837
Mailing address:
  • Phone: 619-464-1165
  • Fax: 619-567-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number657712
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number136486
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15657
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: