Individual
COISHA GABRIELLE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10230 SE CHERRY BLOSSOM DR, PORTLAND, OR 97216-2821
(503) 535-1151
Mailing address
PO BOX 11568, PORTLAND, OR 97211-0568
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10008056
OR
Other
Enumeration date
06/21/2023
Last updated
03/13/2024
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