Healthcare Provider Details

I. General information

NPI: 1326714189
Provider Name (Legal Business Name): HEATHER GRAHAM DNP, APRN, AANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 S STATE ST STE B
DOVER DE
19901-5148
US

IV. Provider business mailing address

1673 S STATE ST # B
DOVER DE
19901-5148
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7246
  • Fax:
Mailing address:
  • Phone: 302-674-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001393
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: