Basic Information
| Provider Information | |||||||||
| NPI: | 1073867347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLITTLE | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNC, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 RIVERSIDE AVE | ||||||||
| Address2: | NICU 4TH FLOOR EAST BUILDING | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122737624 | ||||||||
| FaxNumber: | 6122737625 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 RIVERSIDE AVE | ||||||||
| Address2: | NICU 4TH FLOOR EAST BUILDING | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122737624 | ||||||||
| FaxNumber: | 6122737625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2012 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | R935337 | MN | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.