Organization
GRACE KIDNEY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISE H HALL NP (NP)
(225) 802-0079
Entity
Organization
Contact information
Practice address
4316 DAWSON DR, BATON ROUGE, LA 70805-1429
(225) 802-0079
Mailing address
PO BOX 74075, BATON ROUGE, LA 70874-4075
(225) 802-0079
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2347080
—
LA
Enumeration date
07/02/2020
Last updated
07/03/2020
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