Provider Demographics
NPI:1710717368
Name:HAM, GRACE PRINCESS
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:PRINCESS
Last Name:HAM
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 1:9739 KINGS PARADE BLVD UNIT 424
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5841
Mailing Address - Country:US
Mailing Address - Phone:984-209-2638
Mailing Address - Fax:
Practice Address - Street 1:9739 KINGS PARADE BLVD UNIT 424
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5841
Practice Address - Country:US
Practice Address - Phone:984-209-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula