Provider Demographics
NPI:1588379317
Name:GRACE, NADIYAH
Entity type:Individual
Prefix:
First Name:NADIYAH
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 S SEDALIA WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2257
Mailing Address - Country:US
Mailing Address - Phone:720-361-3631
Mailing Address - Fax:
Practice Address - Street 1:3231 S SEDALIA WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2257
Practice Address - Country:US
Practice Address - Phone:720-361-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel