Provider Demographics
NPI:1730587551
Name:GRAHAM, LAURA ANN (CRNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 PENNYLANE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4541
Mailing Address - Country:US
Mailing Address - Phone:256-434-5449
Mailing Address - Fax:
Practice Address - Street 1:2128 6TH AVE SE STE 501
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6563
Practice Address - Country:US
Practice Address - Phone:256-822-2002
Practice Address - Fax:256-822-2003
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-102638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health