Healthcare Provider Details

I. General information

NPI: 1801678206
Provider Name (Legal Business Name): ALEXANDRIA NICOLE GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MELLON WAY
LATROBE PA
15650-1197
US

IV. Provider business mailing address

403 CONCORD AVE
GREENSBURG PA
15601-1507
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-162460
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: