Healthcare Provider Details

I. General information

NPI: 1831753045
Provider Name (Legal Business Name): ANNA GRAHAM APRN, AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 09/11/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 2ND ST NW
WASHINGTON DC
20001-2003
US

IV. Provider business mailing address

1100 NEW JERSEY AVE SE STE 500
WASHINGTON DC
20003-3326
US

V. Phone/Fax

Practice location:
  • Phone: 202-508-0500
  • Fax:
Mailing address:
  • Phone: 202-715-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number280394
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8309
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1047928
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: