Provider Demographics
NPI:1720323017
Name:GRACE, ADRIANNE MARIE (NP)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:MARIE
Last Name:GRACE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ADRIANNE
Other - Middle Name:MARIE
Other - Last Name:COVARRUBIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:133 N ALTADENA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7325
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8337
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-792-2166
Practice Address - Fax:626-795-0740
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428659363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health