Provider Demographics
NPI:1861541112
Name:GRAHAM, FRANCES ROBIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:ROBIN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:FRANCES
Other - Middle Name:ROBIN
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2670 DIABLO DRIVE,
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406
Mailing Address - Country:US
Mailing Address - Phone:928-855-6071
Mailing Address - Fax:423-884-3277
Practice Address - Street 1:3205 W CORTARO FARMS RD
Practice Address - Street 2:#77
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-1200
Practice Address - Country:US
Practice Address - Phone:520-744-7430
Practice Address - Fax:423-884-3277
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12353363LF0000X
AZAPN2594363LF0000X
AZRN142995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ186164OtherAHCCCS
AZ860285857OtherAPIPA
Q76900Medicare UPIN
TN3342013Medicare PIN