Active NPI
Polly Rae Graham, MBA, RD, LD
- Registered Dietitian
- Davenport, IA
National Provider Identifier
1760698674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 00732
- Practice address
- 1227 E Rusholme St
Davenport, IA 52803-2459 - Phone
- (563) 421-6943
- Fax
- (563) 421-6959
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 00732 | IA | Primary |
Addresses
Primary practice location
1227 E Rusholme St
Davenport, IA 52803-2459
Mailing address
6395 115TH St
Blue Grass, IA 52726-9609
Phone (563) 381-4113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00732 | IA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760698674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6395 115TH ST",
"city": "BLUE GRASS",
"state": "IA",
"postal_code": "527269609",
"telephone_number": "563-381-4113",
"fax_number": "563-421-1714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1227 E RUSHOLME ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032459",
"telephone_number": "563-421-6943",
"fax_number": "563-421-6959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "POLLY",
"middle_name": "RAE",
"name_prefix": "Mrs.",
"credential": "MBA, RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "00732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.