Individual
ELISE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
6545 FRANCE AVE S, EDINA, MN 55435-2131
(952) 848-5600
Mailing address
6545 FRANCE AVE S, EDINA, MN 55435-2131
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3576
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3576
BOARD OF DIETETICS & NUTRITION PRACTIVE
MN
01
—
86044492
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
01/30/2018
Last updated
05/06/2021
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