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General NPI Number Information
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NPI Number | 1568188092
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Entity Type | Individual
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Provider Name | ANNA LORRAINE LIBRADILLA GRAHAM FNP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 8950 E GERMANN RD STE 30
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City | MESA
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State | AZ
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Zip | 85212-5301
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Country | US
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Telephone | 480-735-1451
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Fax |
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Provider Business Mailing Address
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Address Line | 20329 S 187TH PL
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-3598
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Country | US
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Telephone | 480-735-1451
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 218664
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License Number State | AZ
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