Organization
AMAZING GRACE HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR DAVIS (CO-OWNER/NURSE PRACTITIONER)
(952) 288-9921
Entity
Organization
Contact information
Practice address
625 SNELLING AVE N STE A, SAINT PAUL, MN 55104-5585
(952) 288-9921
Mailing address
625 SNELLING AVE N STE A, SAINT PAUL, MN 55104-5585
(763) 381-4188
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
01/10/2020
Last updated
02/11/2022
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