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NPI Code Detail

MEDICARE: ANNA LORRAINE LIBRADILLA GRAHAM FNP

MEDICARE:   ANNA LORRAINE LIBRADILLA GRAHAM  FNP
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
1363LF0000XFamily Nurse Practitioner218664AZ

General Provider Information

NPI Number : 1568188092
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA LORRAINE LIBRADILLA GRAHAM FNP
Provider Business Mailing Address
First Line : 20329 S 187TH PL
Second Line :
City : QUEEN CREEK
State : AZ
Zip : 85142-3598
Country : US
Telephone Number : 480-735-1451
Fax Number :
Provider Business Practice Location Address
First Line : 8950 E GERMANN RD STE 30
Second Line :
City : MESA
State : AZ
Zip : 85212-5301
Country : US
Telephone Number : 480-735-1451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2022
Last Update Date : 05/24/2024

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