Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | DR.0056693 | CO |
Y | 2080P0204X | Pediatric Emergency Doctor | DR.0056693 | CO |
NPI | 1265775043 |
---|---|
Provider Name | Dr. Jessica Margaret Kraynik Graham |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2013 |
Last Update Date | 09/04/2018 |