Basic Information
| Provider Information | |||||||||
| NPI: | 1417364431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACE | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 MURPHY AVE | ||||||||
| Address2: | STE. 301 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153279543 | ||||||||
| FaxNumber: | 6153417583 | ||||||||
| Practice Location | |||||||||
| Address1: | 2011 MURPHY AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153279543 | ||||||||
| FaxNumber: | 6153417583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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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 | 363LA2100X | 18916 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LF0000X | 18916 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.