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General NPI Number Information
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NPI Number | 1144820622
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Entity Type | Individual
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Provider Name | DIYONG S GRAHAM CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 3900 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4594
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Country | US
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Telephone | 152-823-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MONUMENT RD STE 600
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1701
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Country | US
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Telephone | 610-620-4978
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP022699
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License Number State | PA
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