Provider Demographics
NPI:1285800490
Name:GRAHAM, CORA JOYCE (PHD,CNS, APRN, FNP)
Entity type:Individual
Prefix:DR
First Name:CORA
Middle Name:JOYCE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD,CNS, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N RAMPART ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3503
Mailing Address - Country:US
Mailing Address - Phone:504-903-5401
Mailing Address - Fax:504-599-1057
Practice Address - Street 1:517 N RAMPART ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3503
Practice Address - Country:US
Practice Address - Phone:504-903-5401
Practice Address - Fax:504-599-1057
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO2169364S00000X
LAAPO 2169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1894397Medicaid
LA12310562OtherCAQH