Provider Demographics
NPI:1790757623
Name:GRAHAM, DEBRA JEANNE (DNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEANNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JEANNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:619-464-1165
Mailing Address - Fax:619-567-1011
Practice Address - Street 1:4537 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4010
Practice Address - Country:US
Practice Address - Phone:619-229-1895
Practice Address - Fax:619-229-1837
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA657712163W00000X
TN136486163W00000X
CA15657363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics