Provider Demographics
NPI:1194961649
Name:JOSHUA, GRACE (LPN)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 FRANKLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553
Mailing Address - Country:US
Mailing Address - Phone:917-557-4528
Mailing Address - Fax:
Practice Address - Street 1:243 MCDONALD AVENUE
Practice Address - Street 2:4E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1442
Practice Address - Country:US
Practice Address - Phone:917-557-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148253-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse