Basic Information
| Provider Information | |||||||||
| NPI: | 1144201864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLION | ||||||||
| FirstName: | GRACIE | ||||||||
| MiddleName: | MAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8017 FOREST ASH | ||||||||
| Address2: | |||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782334381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162252 | ||||||||
| FaxNumber: | 2109163585 | ||||||||
| Practice Location | |||||||||
| Address1: | 3851 ROGER BROOKE DR | ||||||||
| Address2: | BLDG 3600 BROOKE ARMY MEDICAL CENTER | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162252 | ||||||||
| FaxNumber: | 2109163585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0500X | 589531 | TX | Y | Nursing Service Providers | Registered Nurse | Hemodialysis |
No ID Information.