Individual
GRACE ELLEN SOURILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4920 S 30TH ST, SUITE 103, OMAHA, NE 68107-1590
(402) 734-2028
Mailing address
4920 S 30TH ST, SUITE 103, OMAHA, NE 68107-1590
(402) 734-2028
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
960
NE
Other
Enumeration date
03/15/2012
Last updated
03/15/2012
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