Active NPI
Sara Graham, RN
- Registered Nurse
- Idaho Falls, ID
National Provider Identifier
1669283503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 57510
- Practice address
- 1050 Memorial Dr
Idaho Falls, ID 83402-3410 - Phone
- (208) 419-6283
- NPI assigned
- Jan 20, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 57510 | ID | Primary |
Addresses
Primary practice location
1050 Memorial Dr
Idaho Falls, ID 83402-3410
Mailing address
1055 11TH St
Idaho Falls, ID 83404-5013
Phone (208) 419-6283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57510 | ID | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737331200000",
"number": "1669283503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 11TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834045013",
"telephone_number": "208-419-6283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 MEMORIAL DR",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023410",
"telephone_number": "208-419-6283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "SARA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-20",
"last_updated": "2025-01-20",
"certification_date": "2025-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "57510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.