Individual
VIVIAN L GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1020 NEW RIVER PKWY STE 200, FALLON, NV 89406-7801
(775) 428-2150
(775) 428-2151
Mailing address
2345 E PRATER WAY STE 207, SPARKS, NV 89434-9634
(775) 356-4067
(775) 356-5590
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
809
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11536093
CAQH
—
05
—
1437128873
—
NE
Enumeration date
03/17/2006
Last updated
07/21/2022
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