MEDICARE: GRACE CHARLES

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
1	163W00000X	Registered Nurse	939349	NY

General Provider Information

NPI Number	:	1699638627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE CHARLES

Provider Business Mailing Address
First Line	:	11956 177TH PL
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-1934
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11956 177TH PL
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-1934
Country	:	US
Telephone Number	:	516-782-4317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “ GRACE CHARLES ” Practice Location

Language	Start Address	Practice Location

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