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General NPI Number Information
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NPI Number | 1003610056
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Entity Type | Individual
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Provider Name | MS. GRACE MADALYNNE HARTWICK
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Gender | Female
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 16580 WEDGE PKWY STE 100
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City | RENO
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State | NV
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Zip | 89511-3211
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Country | US
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Telephone | 775-853-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 8715 SCENIC SKY DR
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City | RENO
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State | NV
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Zip | 89506-2287
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Country | US
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Telephone | 916-320-8789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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