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General NPI Number Information
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NPI Number | 1629850151
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Entity Type | Organization
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Legal Business Name | GRACE CLINIC
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 3502 LIBERTY RD
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City | HOUSTON
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State | TX
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Zip | 77026-6243
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Country | US
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Telephone | 713-993-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 3502 LIBERTY RD
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City | HOUSTON
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State | TX
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Zip | 77026-6243
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SHEILA YOUNG
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Credential |
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Telephone | 713-417-0479
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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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