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General NPI Number Information
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NPI Number | 1457851628
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Entity Type | Individual
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Provider Name | SONIA GRACE AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 675 JUSTICE WAY ROOM C0049
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City | INDIANAPOLIS
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State | IN
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Zip | 46203
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Country | US
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Telephone | 877-465-6650
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Fax | 804-294-2775
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Provider Business Mailing Address
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Address Line | 828 RAYMON DR
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City | SEYMOUR
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State | IN
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Zip | 47274-2738
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Country | US
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Telephone | 470-734-4518
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28130736A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 28130636A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71007804B
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71007804A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024193179
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License Number State | VA
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