Healthcare Provider Details

I. General information

NPI: 1548869191
Provider Name (Legal Business Name): SARA M GRAHAM MSN, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

IV. Provider business mailing address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10201142
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: