Provider Demographics
NPI:1306084009
Name:GRAHAM, JEANNE THERESE (AP, LAC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:THERESE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5209
Mailing Address - Country:US
Mailing Address - Phone:941-400-5598
Mailing Address - Fax:
Practice Address - Street 1:2020 ROSE ST STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5209
Practice Address - Country:US
Practice Address - Phone:941-350-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist