1841459088 NPI number — MS. ELIZABETH ARELIA ODELL GRACE M.A.

Table of content: MS. ELIZABETH ARELIA ODELL GRACE M.A. (NPI 1841459088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841459088 NPI number — MS. ELIZABETH ARELIA ODELL GRACE M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODELL GRACE
Provider First Name:
ELIZABETH
Provider Middle Name:
ARELIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841459088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1045
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWARD
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99664-1045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-224-2949
Provider Business Mailing Address Fax Number:
907-224-7081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 RAILWAY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWARD
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99664-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-224-2949
Provider Business Practice Location Address Fax Number:
907-224-7081
Provider Enumeration Date:
06/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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