Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2007014939 | MO |
N | 1223P0221X | Pediatric Dentist | 60612 | KS |
NPI | 1023287760 |
---|---|
Provider Name | Rachael L Graue |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 13/06/2011 |