Individual
NOLLE L GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
EAST 101 STREET, NEW YORK, NY 10029
(212) 241-6500
Mailing address
1505 TELLER AVE APT 1, BRONX, NY 10457-8704
(914) 382-6503
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
021554
NY
Other
Enumeration date
09/21/2017
Last updated
01/14/2020
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