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General NPI Number Information
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NPI Number | 1679761761
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Entity Type | Individual
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Provider Name | GRACE IHSIU TODD RN, CRNP-ADULT
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Gender | Female
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 964 MEZZANINE DR PLANNED PARENTHOOD OF INDIANA AND KENTUCKY
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City | LAFAYETTE
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State | IN
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Zip | 47905-8631
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Country | US
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Telephone | 765-446-8078
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Fax | 765-446-8160
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Provider Business Mailing Address
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Address Line | 964 MEZZANINE DR PLANNED PARENTHOOD OF INDIANA AND KENTUCKY
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City | LAFAYETTE
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State | IN
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Zip | 47905-8631
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Country | US
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Telephone | 765-446-8078
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Fax | 765-446-8160
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 28180419A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 841764
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License Number State | TX
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