Individual
GRACE ANNA BASDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5949 CAMPBELL BLVD, LOCKPORT, NY 14094-9204
(716) 778-8627
Mailing address
5949 CAMPBELL BLVD, LOCKPORT, NY 14094-9204
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030425-01
NY
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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