Healthcare Provider Details

I. General information

NPI: 1982927885
Provider Name (Legal Business Name): DONALD GEORGE GRAHAM NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 GREENWAY DR
PENN HILLS PA
15235-3750
US

IV. Provider business mailing address

332 GREENWAY DR
PENN HILLS PA
15235-3750
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-7992
  • Fax: 412-578-8339
Mailing address:
  • Phone: 412-578-7992
  • Fax: 412-578-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: