Individual
MANDY GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 SE WASHINGTON ST, DALLAS, OR 97338-2834
(503) 917-2083
Mailing address
440 ELLIS ST, FALLS CITY, OR 97344-9731
(503) 580-2109
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
200941991RN
OR
Other
Enumeration date
03/28/2021
Last updated
03/28/2021
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