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General NPI Number Information
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NPI Number | 1366254435
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Entity Type | Organization
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Legal Business Name | GRACE AND GRATITUDE WELLNESS
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 210 HIGHWAY 2 W STE 8
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City | DEVILS LAKE
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State | ND
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Zip | 58301-2913
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Country | US
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Telephone | 701-662-2039
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Fax | 701-662-2049
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Provider Business Mailing Address
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Address Line | 210 HIGHWAY 2 BOX 2
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City | DEVILS LAKE
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State | ND
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Zip | 58301
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Country | US
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Telephone | 701-739-4228
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Fax |
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Authorized Official
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Title or Position | OWNER/DNP
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Name | JESSICA JEAN LARSON
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Credential | DNP, FNP-C
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Telephone | 701-739-4228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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