Individual
MICHELLE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
427 SE 47TH TER, GAINESVILLE, FL 32641-7811
(352) 246-5860
Mailing address
427 SE 47TH TER, GAINESVILLE, FL 32641-7811
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 5216248
FL
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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