Provider Demographics
NPI:1467418590
Name:GRAHEK-LINDSEY, LISA M (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:GRAHEK-LINDSEY
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:10004 KENNERLY ROAD
Mailing Address - Street 2:SUITE 330 A
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2175
Mailing Address - Country:US
Mailing Address - Phone:314-543-5963
Mailing Address - Fax:314-525-4323
Practice Address - Street 1:10004 KENNERLY ROAD
Practice Address - Street 2:SUITE 330 A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2175
Practice Address - Country:US
Practice Address - Phone:314-543-5963
Practice Address - Fax:314-525-4323
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO113896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant