Provider Demographics
NPI:1306240296
Name:GRAHAM, AMY B (ARNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BUSINESS LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1167
Mailing Address - Country:US
Mailing Address - Phone:509-575-4800
Mailing Address - Fax:509-573-3400
Practice Address - Street 1:2501 BUSINESS LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1167
Practice Address - Country:US
Practice Address - Phone:509-575-4800
Practice Address - Fax:509-573-3400
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60508369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily