MEDICARE: MRS. ANNE E. GRAHAM FNP-BC, MSN, FACCWS

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
1	363LF0000X	Family Nurse Practitioner	201394743NP-PP	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639502198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE E. GRAHAM FNP-BC, MSN, FACCWS

Provider Business Mailing Address
First Line	:	1221 DISK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-6638
Country	:	US
Telephone Number	:	541-773-3863
Fax Number	:	541-842-7776

Provider Business Practice Location Address
First Line	:	11160 HIGHWAY 62
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-8025
Country	:	US
Telephone Number	:	541-773-3863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	04/04/2024

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