Provider Demographics
NPI:1598761694
Name:GRAHAM, DONNA (CRNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3724
Mailing Address - Country:US
Mailing Address - Phone:215-517-8850
Mailing Address - Fax:
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:STE 302
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3724
Practice Address - Country:US
Practice Address - Phone:215-517-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007567363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071903Medicare PIN