Individual
GRACE CHARITY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
136 KENTUCKY OAKS, MONTGOMERY, AL 36117-6704
(334) 300-6225
Mailing address
136 KENTUCKY OAKS, MONTGOMERY, AL 36117-6704
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-139053
AL
Other
Enumeration date
12/07/2017
Last updated
12/07/2017
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