MEDICARE: HALLIE GRACE

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
1	163W00000X	Registered Nurse	449157	OH

General Provider Information

NPI Number	:	1932797511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE GRACE

Provider Business Mailing Address
First Line	:	3040 SPRINGER AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 SPRINGER AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2438
Country	:	US
Telephone Number	:	330-591-5754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	01/08/2021

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Directions to “ HALLIE GRACE ” Practice Location

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