Provider Demographics
NPI:1508176694
Name:BRAHAM, MARY ELIZABETH (ANPC)
Entity Type:Individual
Prefix:MS
First Name:MARY ELIZABETH
Middle Name:
Last Name:BRAHAM
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3332
Mailing Address - Country:US
Mailing Address - Phone:602-329-0174
Mailing Address - Fax:
Practice Address - Street 1:233 E SOUTHERN AVE
Practice Address - Street 2:#24256
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5189
Practice Address - Country:US
Practice Address - Phone:602-329-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3650363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health