Provider Demographics
NPI:1285752691
Name:MORSER-GRAHAM, CORINA MARIE (LMP)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:MARIE
Last Name:MORSER-GRAHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 FOREST PL SW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-443-5656
Mailing Address - Fax:425-413-0754
Practice Address - Street 1:465 FOREST PL SW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-443-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA00019316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00019316OtherPROFESSIONAL LICENSE NUMB
WA1689815045OtherEIN #
WAMA00019316OtherPROFESSIONAL LICENSE NUMB