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General NPI Number Information
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NPI Number | 1962607382
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Entity Type | Individual
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Provider Name | SANDRA L GRAHAM RNC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2007
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 4915 42ND AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1730
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Country | US
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Telephone | 763-533-1316
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Fax |
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Provider Business Mailing Address
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Address Line | 6224 CAVELL AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-2606
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Country | US
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Telephone | 763-535-4634
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R 067255-1
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License Number State | MN
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