Basic Information
| Provider Information | |||||||||
| NPI: | 1255867925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALAVE | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | SERIO | ||||||||
| OtherFirstName: | GRACE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N | ||||||||
| Address2: | STE 302 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152842988 | ||||||||
| FaxNumber: | 6152842995 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372364400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152845555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2017 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 63520 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.