Individual
SALLY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
13503 S 30TH ST, BELLEVUE, NE 68123-4632
(402) 708-8636
Mailing address
4715 S 132ND ST, OMAHA, NE 68137-1899
(402) 708-8636
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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