Healthcare Provider Details

I. General information

NPI: 1922825397
Provider Name (Legal Business Name): EARL GRAFF RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 GRASSY CT SW
ALBUQUERQUE NM
87121-2186
US

IV. Provider business mailing address

3315 GRASSY CT SW
ALBUQUERQUE NM
87121-2186
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-2294
  • Fax: 877-747-9662
Mailing address:
  • Phone: 505-234-2294
  • Fax: 877-747-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-79070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: