Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath | ||
N | 225400000X | Rehabilitation Practitioner | ||
N | 226300000X | Kinesiotherapist |
NPI | 1184246498 |
---|---|
Provider Name | Ladonna Graham |
First Address | Smyrna, DE 19977-2228 |
Second Address | Smyrna, DE 19977-2228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2020 |
Last Update Date | 11/05/2020 |