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General NPI Number Information
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NPI Number | 1700798337
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Entity Type | Organization
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Legal Business Name | GRACE MEDICAL WELLNESS GROUP LLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 1115 N STOCKTON HILL RD STE 101
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City | KINGMAN
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State | AZ
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Zip | 86401-6232
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Country | US
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Telephone | 928-263-1481
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Fax | 928-307-7688
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Provider Business Mailing Address
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Address Line | 1115 N STOCKTON HILL RD STE 101
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City | KINGMAN
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State | AZ
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Zip | 86401-6232
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Country | US
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Telephone | 928-263-1481
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Fax | 928-307-7688
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Authorized Official
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Title or Position | OWNER
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Name | DANNI OWENS
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Credential |
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Telephone | 928-715-4783
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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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