| NPI | 1073086997 |
|---|---|
| Former Legal Business Name | GRACE NURSE PRACTITIONER IN PSYCHIATRIC MENTAL HEALTH.P.C |
| Entity Type | Organization |
| Authorized Contact | GRACE ADEOLA ADEPOJU Npp 518-331-2192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-01-03 |