Organization
GRACE HEALTHCARE SERVICES, LLC
Active
Organization
GRACE HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENE L TROTTER FNP (OFFICER)
(618) 643-3051
Entity
Organization
Contact information
Practice address
104 E MARKET ST, MC LEANSBORO, IL 62859-1317
(618) 643-3051
(618) 643-3164
Mailing address
104 E MARKET ST, MC LEANSBORO, IL 62859-1317
(618) 643-3051
(618) 643-3164
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03332007
BCBS #
IL
01
—
1568446805
PERSONAL NPI
IL
05
—
318602171001
—
IL
01
—
788058
HEALTHLINK #
IL
01
—
DG2570
RAILROAD MEDICARE#
IL
01
—
P00425296
RAILROAD MEDICARE #
IL
01
—
Q24440
UPIN #
IL
Enumeration date
01/30/2007
Last updated
04/20/2008
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