Doctor Name: | MARY L GRAHAM |
NPI Number: | 1376620823 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | CP000222 |
Business Practice Address: | 113 Comanche Rd Fort Meade, SD - 577411002 |
Business Phone Number: | 6053477000 |
Business Fax Number: | |
Mailing Address: | 113 Comanche Rd, FORT MEADE |
State: | SD |
Postal Code: | 577411002 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CP000222 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |