Provider Demographics
NPI:1649473620
Name:SCOTT-GRAHAM, CONNIE DOREEN (RN)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:DOREEN
Last Name:SCOTT-GRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85112
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AL
Mailing Address - Zip Code:85754
Mailing Address - Country:US
Mailing Address - Phone:520-225-3284
Mailing Address - Fax:
Practice Address - Street 1:1010 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-225-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN077698163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ835241Medicaid