Individual
ELIZABETH JEAN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-C
Contact information
Practice address
3011 N MICHIGAN ST, PITTSBURG, KS 66762-2546
(620) 231-1960
(620) 231-2808
Mailing address
689 E 19TH AVE, EUGENE, OR 97401-4304
(541) 868-1876
(541) 868-0932
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
5375433011
KS
363LP2300X
Primary Care Nurse Practitioner
Primary
202006374NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002207
MEDICARE PTAN
KS
05
—
200875510C
—
KS
Enumeration date
08/17/2011
Last updated
02/18/2021
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