Healthcare Provider Details

I. General information

NPI: 1528253747
Provider Name (Legal Business Name): GRACE GRAU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE GRAU VACHERESSE CRNP

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S SUITE 305
BIRMINGHAM AL
35205-1200
US

IV. Provider business mailing address

2700 10TH AVE S SUITE 305
BIRMINGHAM AL
35205-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-0139
  • Fax: 205-939-4997
Mailing address:
  • Phone: 205-939-0139
  • Fax: 205-939-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-096670
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: