Healthcare Provider Details

I. General information

NPI: 1235499302
Provider Name (Legal Business Name): MRS. GRACE MARIE FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4649 COAL BANK DR
RAPID CITY SD
57701-6542
US

IV. Provider business mailing address

4649 COAL BANK DR
RAPID CITY SD
57701-6542
US

V. Phone/Fax

Practice location:
  • Phone: 541-621-3984
  • Fax:
Mailing address:
  • Phone: 541-621-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: