Healthcare Provider Details

I. General information

NPI: 1518775501
Provider Name (Legal Business Name): GRACE SOLIPACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WALNUT ST
PHILADELPHIA PA
19107-5109
US

IV. Provider business mailing address

840 WALNUT ST
PHILADELPHIA PA
19107-5109
US

V. Phone/Fax

Practice location:
  • Phone: 215-625-6630
  • Fax:
Mailing address:
  • Phone: 215-625-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP029489
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: