Provider Demographics
NPI:1841488491
Name:GRAHAM, AMANDA (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1455 W 16TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8921
Mailing Address - Country:US
Mailing Address - Phone:928-510-0899
Mailing Address - Fax:928-447-2501
Practice Address - Street 1:1455 W 16TH ST STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8921
Practice Address - Country:US
Practice Address - Phone:928-510-0899
Practice Address - Fax:928-447-2501
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical