Provider Demographics
NPI:1134433600
Name:GRAHAM, CANDACE LYNN
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:LYNN
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 1:5805 93RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3636
Mailing Address - Country:US
Mailing Address - Phone:806-252-6367
Mailing Address - Fax:806-698-6534
Practice Address - Street 1:5805 93RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3636
Practice Address - Country:US
Practice Address - Phone:806-252-6367
Practice Address - Fax:806-698-6534
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328272471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography