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General NPI Number Information
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NPI Number | 1487521050
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Entity Type | Individual
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Provider Name | GRACE HENDRICK RN
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Gender | Female
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 316 W COPPERFIELD DR
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City | DUNLAP
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State | IL
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Zip | 61525-9653
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Country | US
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Telephone | 309-472-4721
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Fax |
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Provider Business Mailing Address
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Address Line | 15110 W BITTERSWEET CT
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City | BRIMFIELD
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State | IL
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Zip | 61517-9677
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Country | US
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Telephone | 630-854-8043
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 041425468
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License Number State | IL
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