Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 609376 | CA |
NPI | 1003183252 |
---|---|
Provider Name | Miss Elizabeth Clare Graham |
First Address | Juneau, AK 99801-7837 |
Second Address | Juneau, AK 99801-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 10/02/2016 |