Healthcare Provider Details

I. General information

NPI: 1689058620
Provider Name (Legal Business Name): ARLENE GRAHAM LMT 7318
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MOUNTAIN RD NE APT 4
ALBUQUERQUE NM
87102-2374
US

IV. Provider business mailing address

213 MOUNTAIN RD NE APT 4
ALBUQUERQUE NM
87102-2374
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-4179
  • Fax:
Mailing address:
  • Phone: 505-373-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7318
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: