Sandra Graham
Individual provider Active NPI Registered Nurse · West Milwaukee, WI
NPI 1336775451 · NPPES record last updated Mar 20, 2020
Key facts
- NPI
- 1336775451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 168033-30 (WI)
- Practice address
- 1610 Miller Park Way
West Milwaukee, WI 53214-3604 - Phone
- (414) 499-1750
- NPI assigned
- Mar 20, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 168033-30 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 168033-30 | WI | Yes |
Addresses
Primary practice location
1610 Miller Park Way
West Milwaukee, WI 53214-3604
Mailing address
3135 S 10TH St
Milwaukee, WI 53215-4729
Phone (414) 499-1750
Other providers in West Milwaukee, WI
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- Michael Gremban
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- Audra L Hale
- Kourtney K Haller
All providers in West Milwaukee, WI · Registered Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.