Individual
MOIRA E GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1117 W DE LA ROSA ST, DEL RIO, TX 78840
(830) 768-4800
(830) 768-4844
Mailing address
PO BOX 1470, EAGLE PASS, TX 78853-1470
(830) 773-8917
(830) 773-1892
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
633353
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
A109911
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1411407-08
—
TX
Enumeration date
02/10/2006
Last updated
11/09/2023
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