Healthcare Provider Details

I. General information

NPI: 1124161302
Provider Name (Legal Business Name): GRACE HUBBARD MSN, RN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8520 SIX FORKS RD SUITE 204
RALEIGH NC
27615-3095
US

IV. Provider business mailing address

3410 CAMBRIDGE RD
DURHAM NC
27707-4508
US

V. Phone/Fax

Practice location:
  • Phone: 919-676-1497
  • Fax: 919-676-1430
Mailing address:
  • Phone: 919-403-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number200001387175
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200001387175
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number200001387175
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: