Individual
KATHLEEN POWERS GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
15700 37TH AVE N STE 300, PLYMOUTH, MN 55446-3661
(612) 871-1145
Mailing address
1973 SLOAN PL, MAPLEWOOD, MN 55117-2084
(612) 871-1145
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
A0712144
MN
363LG0600X
Gerontology Nurse Practitioner
G0712013
MN
Other
Enumeration date
10/30/2012
Last updated
04/24/2018
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