Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC. 2105 | OH |
NPI | 1578604781 |
---|---|
Provider Name | Dr. Shiloh Graham |
First Address | Springboro, OH 45066-9234 |
Second Address | Springboro, OH 45066-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000289435 | ANTHEM PIN NUMBER (01) | OH |
351565 | UHC PIN NUMBER (01) | OH |
U51246 | (02) | OH |