Organization
GRACE FAMILY PRACTICE LLC
Active
Organization
GRACE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ANN ROCHELLE (CONTRACT MANAGER, CFO)
(330) 473-6314
Entity
Organization
Contact information
Practice address
7368 COUNTY ROAD 623 UNIT B, MILLERSBURG, OH 44654-9256
(330) 473-6314
(330) 473-6321
Mailing address
7368 COUNTY ROAD 623 UNIT B, MILLERSBURG, OH 44654-9256
(330) 473-6314
(330) 473-6321
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
COA 13542-NP
OH
367A00000X
Advanced Practice Midwife
COA 12493-NM
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143152
—
OH
Enumeration date
09/04/2015
Last updated
08/11/2019
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