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General NPI Number Information
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NPI Number | 1154903086
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Entity Type | Individual
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Provider Name | DANIELLE N GRAHAM
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Gender | Female
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 2637 E GULF TO LAKE HWY
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City | INVERNESS
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State | FL
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Zip | 34453-3216
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Country | US
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Telephone | 352-637-5180
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Fax | 352-423-1410
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Provider Business Mailing Address
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Address Line | 3404 S ROSE PT
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City | INVERNESS
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State | FL
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Zip | 34450-6307
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Country | US
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Telephone | 352-422-4712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO7476
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License Number State | FL
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