Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA55822 | FL |
NPI | 1831327261 |
---|---|
Provider Name | Nicole Danielle Graham |
First Address | Brooksville, FL 34601-7714 |
Second Address | Tampa, FL 33603-1405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 24/06/2009 |