Provider Demographics
NPI:1629583489
Name:GRAHAM, LISA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GRAHAM
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 1:1704 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-1919
Mailing Address - Country:US
Mailing Address - Phone:267-222-0929
Mailing Address - Fax:
Practice Address - Street 1:1704 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-1919
Practice Address - Country:US
Practice Address - Phone:267-222-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2017-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist