Provider Demographics
NPI:1033100631
Name:GRABHAM, DANA ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ELIZABETH
Last Name:GRABHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:ELIZABETH
Other - Last Name:MISSELHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5434 E BARWICK DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-2404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3929 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2112
Practice Address - Country:US
Practice Address - Phone:602-923-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1012146D00000X
AZ2746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860373636OtherHUMANA GROUP #
AZ453051001OtherGROUP HEALTH GRP #
AZ3981220OtherEVERCARE GROUP #
AZ740771Medicaid
AZAW1436OtherHEALTHNET GRP #
AZ104400Medicare PIN
AZ3981220OtherEVERCARE GROUP #