| NPI | 1225786825 |
|---|---|
| Former Name | MARY GRACE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.028777) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.546416) |
| 163W00000X Registered Nurse (Licence: NC 328533) | |
| Enumeration Date | 2022-03-13 |
| Last Update Date | 2023-11-13 |