Healthcare Provider Details

I. General information

NPI: 1316640337
Provider Name (Legal Business Name): GRACE ELIZABETH FALK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 1100
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

7650 E 32ND ST N APT 608
WICHITA KS
67226-1288
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6200
  • Fax:
Mailing address:
  • Phone: 913-416-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: