MEDICARE: AMANDA GRAHAM PA-C

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	363AM0700X	Medical Physician Assistant	3680	AZ

General Provider Information

NPI Number	:	1841488491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GRAHAM PA-C

Provider Business Mailing Address
First Line	:	1455 W 16TH ST STE A
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8921
Country	:	US
Telephone Number	:	928-510-0899
Fax Number	:	928-447-2501

Provider Business Practice Location Address
First Line	:	1455 W 16TH ST STE A
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8921
Country	:	US
Telephone Number	:	928-510-0899
Fax Number	:	928-447-2501

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	07/01/2024

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