Lavern Graham, STUDENT

NPI #1104287499 in Gordonville, Texas

Provider Information

NPI Number: 1104287499
Entity Type: Individual
Name: Lavern Graham, STUDENT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Credential: STUDENT
Enumeration Date: Mar 14, 2016
Last Updated: Mar 14, 2016

Practice Location

Address: 43 PLUM LN
City: Gordonville
State: Texas
ZIP Code: 76245-2342
Phone: (903) 651-1803

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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