| NPI | 1760856157 |
|---|---|
| Former Name | GRACE CHICKADONZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY NY373483) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 373483-1) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2020-04-24 |