Healthcare Provider Details

I. General information

NPI: 1396044012
Provider Name (Legal Business Name): GRACE HASSAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WOODMAN DR
DAYTON OH
45432-1400
US

IV. Provider business mailing address

1010 WOODMAN DR
DAYTON OH
45432-1400
US

V. Phone/Fax

Practice location:
  • Phone: 937-252-2000
  • Fax: 937-252-3700
Mailing address:
  • Phone: 937-252-2000
  • Fax: 937-252-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.12234-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: