Basic Information
| Provider Information | |||||||||
| NPI: | 1801001706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2868 ACTON ROAD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059688360 | ||||||||
| FaxNumber: | 2059688361 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 RICE MINE ROAD N | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053913099 | ||||||||
| FaxNumber: | 2053919793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163WP0808X | 1055943 | AL | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.