Healthcare Provider Details

I. General information

NPI: 1932670775
Provider Name (Legal Business Name): GRACE NRIAGU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKSTER RD
FARMINGTON HILLS MI
48334-5326
US

IV. Provider business mailing address

27777 INKSTER RD
FARMINGTON HILLS MI
48334-5326
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703120412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: