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NPI Code Detail

MEDICARE: MRS. DEBORAH SUZANNE GRACE BS

MEDICARE: MRS. DEBORAH SUZANNE GRACE BS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1689729378
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBORAH SUZANNE GRACE BS
Provider Business Mailing Address
First Line : 320 CUSTER RD
Second Line :
City : RICHARDSON
State : TX
Zip : 75080-5623
Country : US
Telephone Number : 972-490-9055
Fax Number : 972-490-9058
Provider Business Practice Location Address
First Line : 320 CUSTER RD
Second Line :
City : RICHARDSON
State : TX
Zip : 75080-5623
Country : US
Telephone Number : 972-490-9055
Fax Number : 972-490-9058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 12/12/2007

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