Healthcare Provider Details

I. General information

NPI: 1720804677
Provider Name (Legal Business Name): GRACE WALLACE NORTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 RIVERSIDE DR
AUGUSTA ME
04330-8302
US

IV. Provider business mailing address

841 RIVERSIDE DR
AUGUSTA ME
04330-8302
US

V. Phone/Fax

Practice location:
  • Phone: 844-294-5306
  • Fax:
Mailing address:
  • Phone: 844-294-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN65237
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: