Healthcare Provider Details

I. General information

NPI: 1386773968
Provider Name (Legal Business Name): CAROL A GRAFFORD RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR DIABETES EDUCATION
HANCOCK MI
49930-1569
US

IV. Provider business mailing address

1023 SUMMIT ST
HANCOCK MI
49930-1532
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1562
  • Fax: 906-483-1149
Mailing address:
  • Phone: 906-487-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: