Healthcare Provider Details

I. General information

NPI: 1770835456
Provider Name (Legal Business Name): GRACE SPLETZER CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 AVIS DR
ANN ARBOR MI
48108-9649
US

IV. Provider business mailing address

2750 SHADOW VIEW DR #330
EUGENE OR
97408-4641
US

V. Phone/Fax

Practice location:
  • Phone: 734-213-3960
  • Fax:
Mailing address:
  • Phone: 330-984-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number2196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: