Provider Demographics
NPI:1962607382
Name:GRAHAM, SANDRA L (RNC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 CAVELL AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2606
Mailing Address - Country:US
Mailing Address - Phone:763-535-4634
Mailing Address - Fax:
Practice Address - Street 1:4915 42ND AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1730
Practice Address - Country:US
Practice Address - Phone:763-533-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 067255-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse