Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1134686728 |
---|---|
Provider Name | Brealin Graham |
First Address | Phoenix, AZ 85050-1006 |
Second Address | Mesa, AZ 85215-1046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 01/07/2020 |