Provider Demographics
NPI:1093218463
Name:GRAHE, AIMEE LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:GRAHE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N. POTOMAC STREET
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-992-0197
Mailing Address - Fax:301-992-0197
Practice Address - Street 1:89 W LEE ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6030
Practice Address - Country:US
Practice Address - Phone:301-797-3737
Practice Address - Fax:301-302-7802
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02499171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist