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General NPI Number Information
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NPI Number | 1043307192
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Entity Type | Individual
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Provider Name | SUSAN GRAHAM PA
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 1308 VIVIAN ST
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City | LONGMONT
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State | CO
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Zip | 80501-3217
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Country | US
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Telephone | 800-628-7828
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 E ELIZABETH ST STE 2
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City | FORT COLLINS
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State | CO
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Zip | 80524-4044
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Country | US
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Telephone | 970-493-9193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1819
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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