Provider Demographics
NPI:1033173380
Name:GRAHAM, ANNETTE S (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3019
Mailing Address - Country:US
Mailing Address - Phone:804-282-6953
Mailing Address - Fax:
Practice Address - Street 1:5507 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3019
Practice Address - Country:US
Practice Address - Phone:804-282-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166681363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01120OtherMEDICARE GROUP PTAN
VAC05844OtherMEDICARE GROUP PTAN
VAVV7356AMedicare PIN
VAC05844OtherMEDICARE GROUP PTAN