Individual
MARIETTA GRAHAM-LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CS FNP
Contact information
Practice address
900 E CHERRY ST, TROY, MO 63379-1429
(636) 528-8585
(636) 528-8430
Mailing address
900 E CHERRY ST, TROY, MO 63379-1429
(636) 528-8585
(636) 528-8430
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
083458
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424021202
—
MO
Enumeration date
12/15/2005
Last updated
06/03/2015
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