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Individual
GRACE LUISE TAKISH
Active
Individual
GRACE LUISE TAKISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704318984
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06376
BCBSM
—
05
—
381958736
—
MI
Enumeration date
08/08/2024
Last updated
04/17/2025
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