Provider Demographics
NPI:1992310478
Name:SMITH, GRACE (SONOGRAPHER)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:SONOGRAPHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 W 64TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3114
Mailing Address - Country:US
Mailing Address - Phone:219-746-6662
Mailing Address - Fax:
Practice Address - Street 1:2055 W 64TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3114
Practice Address - Country:US
Practice Address - Phone:219-746-6662
Practice Address - Fax:219-370-0508
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography