Provider Demographics
NPI:1396245346
Name:GRACY, AMALIA (LVM)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:GRACY
Suffix:
Gender:F
Credentials:LVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N BINKLEY ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5142
Mailing Address - Country:US
Mailing Address - Phone:903-816-1451
Mailing Address - Fax:
Practice Address - Street 1:1305 N BINKLEY ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5142
Practice Address - Country:US
Practice Address - Phone:903-816-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154647164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse