Provider Demographics
NPI:1902130933
Name:GRAHAM, EMILY R (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RD, LD, CDE
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5100
Mailing Address - Fax:515-643-5150
Practice Address - Street 1:411 LAUREL ST STE 3262
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3027
Practice Address - Country:US
Practice Address - Phone:515-643-5100
Practice Address - Fax:515-643-5150
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered