Individual
MRS. ANDREA MARIE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,LD
Contact information
Practice address
450 E SIGLER AVE, MEMPHIS, MO 63555-1726
(660) 465-8511
Mailing address
450 EAST SIGLER AVE., MEMPHIS, MO 63555
(660) 465-8511
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2013034940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4848001
MEDICARE PTAN
MO
Enumeration date
09/23/2013
Last updated
04/22/2016
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