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General NPI Number Information
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NPI Number | 1790757623
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Entity Type | Individual
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Provider Name | DEBRA JEANNE GRAHAM DNP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 4537 COLLEGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-4010
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Country | US
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Telephone | 619-229-1895
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Fax | 619-229-1837
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 619-464-1165
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Fax | 619-567-1011
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 657712
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 136486
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 15657
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 15657
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License Number State | CA
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