Doctor Name: | MRS. TERESA KEM GRAHAM |
NPI Number: | 1467582197 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | NP-09190 |
Business Practice Address: | 8765 Lewis Ave Temperance, MI - 481829583 |
Business Phone Number: | 7348473802 |
Business Fax Number: | 7348473418 |
Mailing Address: | 225 Riverside Ave, ADRIAN |
State: | MI |
Postal Code: | 492211539 |
Phone Number: | 5172631800 |
Fax Number: | 5172631866 |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 12/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP-09190 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |