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General NPI Number Information
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NPI Number | 1992105894
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Entity Type | Individual
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Provider Name | GRACE MAINA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 10/26/2014
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Provider Practice Location Address
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Address Line | 1104 HIDDEN RDG APT 2005
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City | IRVING
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State | TX
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Zip | 75038-7973
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Country | US
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Telephone | 469-226-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 HIDDEN RDG APT 2005
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City | IRVING
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State | TX
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Zip | 75038-7973
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Country | US
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Telephone | 469-226-1159
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 126399
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 126399
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License Number State | TX
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