MEDICARE: MRS. PATRICIA ELLEN GRAHAM ED.D, FNP-BC, MSN

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	A-070226	IA

General Provider Information

NPI Number	:	1710265764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ELLEN GRAHAM ED.D, FNP-BC, MSN

Provider Business Mailing Address
First Line	:	4706 STONERIDGE CT
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-9767
Country	:	US
Telephone Number	:	402-212-1307
Fax Number	:

Provider Business Practice Location Address
First Line	:	4706 STONERIDGE CT
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-9767
Country	:	US
Telephone Number	:	402-212-1307
Fax Number	:

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

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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