Basic Information
| Provider Information | |||||||||
| NPI: | 1780026336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | AMITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM, WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 839 W CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203092506 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 839 W CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203092506 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2013 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | 95100740 | CA | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 174N00000X | 10725971 | AZ | N | Other Service Providers | Lactation Consultant, Non-RN | 363LW0102X | 95011742 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | 236037 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.