Healthcare Provider Details

I. General information

NPI: 1083285969
Provider Name (Legal Business Name): JULIE ANN GRAHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DOLLARD FARM WAY
ELLSWORTH ME
04605-2401
US

IV. Provider business mailing address

32 RESORT WAY
ELLSWORTH ME
04605-1717
US

V. Phone/Fax

Practice location:
  • Phone: 248-921-3211
  • Fax:
Mailing address:
  • Phone: 207-664-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211268
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: