Provider Demographics
NPI:1154141018
Name:EBERLE, GRACE LUTTRELL-PETTIT (CVPD, CYT, CKYT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LUTTRELL-PETTIT
Last Name:EBERLE
Suffix:
Gender:F
Credentials:CVPD, CYT, CKYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11058 WYLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3440
Mailing Address - Country:US
Mailing Address - Phone:314-304-8588
Mailing Address - Fax:
Practice Address - Street 1:11058 WYLESTONE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3440
Practice Address - Country:US
Practice Address - Phone:314-304-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula