Individual
LAKISHA GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2213 DREXEL AVE, FORT WAYNE, IN 46806-1382
(260) 715-5312
Mailing address
2213 DREXEL AVE, FORT WAYNE, IN 46806-1382
(260) 715-5312
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Enumeration date
01/08/2024
Last updated
01/28/2024
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