Individual
GRACE COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
865 NORTHERN BLVD, GREAT NECK, NY 11021-5335
(516) 622-5114
Mailing address
24079 67TH AVE, DOUGLASTON, NY 11362-1926
(718) 869-4356
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F352163-01
NY
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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