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NPI Code Detail

MEDICARE: DIVINE GRACE LLC

MEDICARE: DIVINE GRACE LLC
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 Practitioner
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1801516687
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE GRACE LLC
Provider Business Mailing Address
First Line : 6751 N SUNSET BLVD STE 320
Second Line :
City : GLENDALE
State : AZ
Zip : 85305-3155
Country : US
Telephone Number : 602-621-7561
Fax Number : 602-837-5300
Provider Business Practice Location Address
First Line : 6751 N SUNSET BLVD STE 320
Second Line :
City : GLENDALE
State : AZ
Zip : 85305-3155
Country : US
Telephone Number : 602-621-7561
Fax Number : 602-837-5300
Authorized Official
Title or Position : NP-BC
Name : SHARON UCHECHI JOSHUA
Credential : FNP-C, PMHNP-BC
Telephone Number : 602-621-7561
Provider Enumeration Date : 08/31/2022
Last Update Date : 12/04/2024

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Directions to “DIVINE GRACE LLC ” Practice Location

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