Provider Demographics
NPI:1750098745
Name:GRAHAM, ALEXANDRA LEIGH
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEIGH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-0760
Mailing Address - Country:US
Mailing Address - Phone:360-539-8487
Mailing Address - Fax:360-358-9944
Practice Address - Street 1:9333 MARTIN WAY E STE 214
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5969
Practice Address - Country:US
Practice Address - Phone:360-539-8487
Practice Address - Fax:360-358-9944
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic