Provider Demographics
NPI:1134686728
Name:GRAHAM, BREALIN (CPM)
Entity Type:Individual
Prefix:
First Name:BREALIN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71311
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1006
Mailing Address - Country:US
Mailing Address - Phone:602-309-2728
Mailing Address - Fax:
Practice Address - Street 1:6730 E PRESTON ST UNIT 28
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1046
Practice Address - Country:US
Practice Address - Phone:602-309-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife