=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326802745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL OF GRACE CONSULTING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2024
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HORIZON CENTER BLVD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08691-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-925-9330
-----------------------------------------------------
Fax | 856-298-4011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 HORIZON CENTER BLVD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08691-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-925-9330
-----------------------------------------------------
Fax | 856-298-4011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMAKA AKPUNONU
-----------------------------------------------------
Credential | APN
-----------------------------------------------------
Telephone | 215-868-4433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------