Provider Demographics
NPI:1609864479
Name:GRAHAM, NANCY (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:PUETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:182 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2860
Mailing Address - Country:US
Mailing Address - Phone:508-457-0088
Mailing Address - Fax:508-540-9613
Practice Address - Street 1:182 PALMER AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2860
Practice Address - Country:US
Practice Address - Phone:508-457-0088
Practice Address - Fax:508-457-0088
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160848363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0326348Medicaid
MA0326348Medicaid
Q18323Medicare UPIN
MANP4602Medicare ID - Type Unspecified