Provider Demographics
NPI:1821386095
Name:GRAHAM, ANJALIE ROSE (APRN-RX)
Entity Type:Individual
Prefix:
First Name:ANJALIE
Middle Name:ROSE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1752
Mailing Address - Country:US
Mailing Address - Phone:808-326-5629
Mailing Address - Fax:
Practice Address - Street 1:75-5751 KUAKINI HWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1752
Practice Address - Country:US
Practice Address - Phone:808-326-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1362363LF0000X
HIRX-338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily