Provider Demographics
NPI:1164262143
Name:LI, GRACE (DNP FNP - C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DNP FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4365 E PECOS RD STE 134
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8053
Mailing Address - Country:US
Mailing Address - Phone:480-840-9155
Mailing Address - Fax:480-840-9320
Practice Address - Street 1:4365 E PECOS RD STE 134
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8053
Practice Address - Country:US
Practice Address - Phone:480-840-9155
Practice Address - Fax:480-840-9320
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ242662363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care