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NPI Code Detail

MEDICARE: DONNA F GRACE C.R.N.P.

MEDICARE: DONNA F GRACE C.R.N.P.
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1-033018AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2D078OTHERALMEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11508822313OTHERGROUP NPI NUMBER

General Provider Information

NPI Number : 1750346466
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA F GRACE C.R.N.P.
Provider Business Mailing Address
First Line : 635 W COLLEGE ST
Second Line :
City : FLORENCE
State : AL
Zip : 35630-5313
Country : US
Telephone Number : 256-764-3431
Fax Number : 256-765-2036
Provider Business Practice Location Address
First Line : 635 W COLLEGE ST
Second Line :
City : FLORENCE
State : AL
Zip : 35630-5313
Country : US
Telephone Number : 256-764-3431
Fax Number : 256-765-2036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 07/11/2007

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