Individual
JUSTIN WILLIAM GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
635 N 152ND CIR, OMAHA, NE 68154-1801
(308) 631-8533
Mailing address
970 S 192ND CT UNIT 108, ELKHORN, NE 68022-3304
(308) 631-8533
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
75076
NE
367500000X
Certified Registered Nurse Anesthetist
Primary
101710
NE
Other
Enumeration date
06/24/2021
Last updated
07/14/2022
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