Provider Demographics
NPI:1538956958
Name:HORGAN, GRACE ANN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:HORGAN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8721 CAPISTRANO WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3405
Mailing Address - Country:US
Mailing Address - Phone:703-268-9883
Mailing Address - Fax:
Practice Address - Street 1:8721 CAPISTRANO WAY
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3405
Practice Address - Country:US
Practice Address - Phone:703-268-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5044133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered