Basic Information
| Provider Information | |||||||||
| NPI: | 1417525361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | EDWARD | ||||||||
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| Credential: | APRN / PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4029 DEAN MARTIN DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891034138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028482256 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4029 DEAN MARTIN DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891034138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028482256 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2021 | ||||||||
| LastUpdateDate: | 02/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 842896 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.