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General NPI Number Information
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NPI Number | 1528614674
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Entity Type | Organization
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Legal Business Name | GRACE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 188 ONVILLE RD
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City | STAFFORD
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State | VA
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Zip | 22556-3805
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Country | US
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Telephone | 540-779-1648
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Fax | 540-602-7062
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Provider Business Mailing Address
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Address Line | 3 SUTTON CT
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City | STAFFORD
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State | VA
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Zip | 22554-8335
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Country | US
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Telephone | 360-970-7708
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Fax | 703-441-2574
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | COLLETTE F NGANTE
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Credential | PMHNP-BC
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Telephone | 360-970-7708
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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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 |
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License Number State |
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