Provider Demographics
NPI:1881668747
Name:GRAHAM, CATHLEEN JANE (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:JANE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 FESSLER ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-6427
Mailing Address - Country:US
Mailing Address - Phone:941-460-8275
Mailing Address - Fax:941-460-8275
Practice Address - Street 1:1721 FESSLER ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-6427
Practice Address - Country:US
Practice Address - Phone:239-565-4740
Practice Address - Fax:239-565-4740
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2962742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1925OtherBC/BS FL
591783920OtherCHAMPUS
FLG1925OtherBC/BS FL