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NPI Code Detail

MEDICARE: MRS. ASHLEY GRACE FNP-BC

MEDICARE: MRS. ASHLEY GRACE FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner277001154IL

General Provider Information

NPI Number : 1114265725
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEY GRACE FNP-BC
Provider Business Mailing Address
First Line : 9551 171ST ST
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-6109
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 9551 171ST ST
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-6109
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2013
Last Update Date : 04/07/2026

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