Provider Demographics
NPI:1437960903
Name:GRAHAM, DANETTE (RN)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N 382ND LN
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:AZ
Mailing Address - Zip Code:85354-8234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35220 W BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:AZ
Practice Address - Zip Code:85354-7542
Practice Address - Country:US
Practice Address - Phone:623-474-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN199036163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool