Provider Demographics
NPI:1710265764
Name:GRAHAM, PATRICIA ELLEN (EDD, FNP-BC, MSN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:EDD, FNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9767
Mailing Address - Country:US
Mailing Address - Phone:402-212-1307
Mailing Address - Fax:
Practice Address - Street 1:4706 STONERIDGE CT
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9767
Practice Address - Country:US
Practice Address - Phone:402-212-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-070226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily