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NPI Code Detail

MEDICARE: ERIN GRAHAM

MEDICARE:   ERIN  GRAHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN591965PA
2363LF0000XFamily Nurse PractitionerSP027148PA

General Provider Information

NPI Number : 1174782098
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN GRAHAM
Provider Business Mailing Address
First Line : 27 E TULPEHOCKEN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19144-2027
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4601 MARKET ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-4636
Country : US
Telephone Number : 215-707-4630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2008
Last Update Date : 05/03/2024

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Directions to “ ERIN GRAHAM ” Practice Location

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