Individual
LAURA L. GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
235 W WAYNE ST, MAUMEE, OH 43537-2124
(419) 893-9413
(419) 893-0026
Mailing address
4235 SECOR RD, TOLEDO, OH 43623-4231
(419) 893-9413
(419) 893-0026
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-00248
NC
363AM0700X
Medical Physician Assistant
Primary
50001414RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00663286
RAILROAD MEDICARE
NC
Enumeration date
01/28/2006
Last updated
07/21/2022
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