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General NPI Number Information
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NPI Number | 1114709060
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Entity Type | Individual
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Provider Name | ELLEN GRAPPE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 1800 LINE AVE OFC 307
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City | SHREVEPORT
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State | LA
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Zip | 71101-4612
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Country | US
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Telephone | 318-379-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 E 70TH ST # 52421
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City | SHREVEPORT
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State | LA
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Zip | 71105-0002
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Country | US
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Telephone | 659-243-9091
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 211282
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License Number State | LA
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