| Doctor Name: | BRENDA LEE GRAHAM |
| NPI Number: | 1114997624 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4704218257 |
| Business Practice Address: | 7751 Byron Center Ave Sw Suite C Byron Center, MI - 493158001 |
| Business Phone Number: | 6162677668 |
| Business Fax Number: | |
| Mailing Address: | 100 Michigan St Ne, Mc 845 GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495032560 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2006 |
| NPI Last Update Date: | 08/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 4704218257 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |