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General NPI Number Information
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NPI Number | 1720810492
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Entity Type | Individual
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Provider Name | GRACE MBA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 3261 OLD WASHINGTON RD STE 2020
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City | WALDORF
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State | MD
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Zip | 20602-3231
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Country | US
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Telephone | 301-710-4218
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Fax | 301-396-7346
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Provider Business Mailing Address
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Address Line | 6012 BLACK BEAR CT
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City | WALDORF
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State | MD
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Zip | 20603-4342
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Country | US
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Telephone | 240-413-4491
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP500020241
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License Number State | DC
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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 | AC006732
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License Number State | MD
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