Provider Demographics
NPI:1194159624
Name:MBYIRUKIRA, GRACE BINTU (PA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:BINTU
Last Name:MBYIRUKIRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 N GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7514
Mailing Address - Country:US
Mailing Address - Phone:214-827-6880
Mailing Address - Fax:214-827-0520
Practice Address - Street 1:1717 N GARRETT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7514
Practice Address - Country:US
Practice Address - Phone:214-827-6880
Practice Address - Fax:214-827-0520
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant