Provider Demographics
NPI:1427570514
Name:GRAHAM, MICHALENE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHALENE
Middle Name:MARIE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHALENE
Other - Middle Name:MARIE
Other - Last Name:AUTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 PEMBROOK CT APT E
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2765
Mailing Address - Country:US
Mailing Address - Phone:412-849-3513
Mailing Address - Fax:
Practice Address - Street 1:10 PEMBROOK CT APT E
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-2765
Practice Address - Country:US
Practice Address - Phone:412-849-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059131363AM0700X
TXPA15945363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical