Provider Demographics
NPI:1376577643
Name:GRAHAM, AMY D (CRNA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CRNA
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 980
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-0980
Mailing Address - Country:US
Mailing Address - Phone:308-324-5651
Mailing Address - Fax:308-324-8359
Practice Address - Street 1:1201 N ERIE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1560
Practice Address - Country:US
Practice Address - Phone:308-324-5651
Practice Address - Fax:308-324-8359
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100950367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470687526AMedicaid
NE280241Medicare PIN