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NPI Code Detail

MEDICARE: GRACE NICOLE NAMES

MEDICARE: GRACE NICOLE NAMES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1124694609
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE NICOLE NAMES
Provider Business Mailing Address
First Line : 3108 5TH ST S APT.21
Second Line :
City : MOORHEAD
State : MN
Zip : 56560
Country : US
Telephone Number : 320-424-9779
Fax Number :
Provider Business Practice Location Address
First Line : 4152 30TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58104-8524
Country : US
Telephone Number : 320-424-9779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2021
Last Update Date : 06/03/2021

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Directions to “ GRACE NICOLE NAMES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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