Provider Demographics
NPI:1730833724
Name:WARWICK, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WARWICK
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 1:599 N CHURCH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1004
Mailing Address - Country:US
Mailing Address - Phone:724-542-5349
Mailing Address - Fax:724-542-4658
Practice Address - Street 1:505 N PITTSBURGH STREET
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3220
Practice Address - Country:US
Practice Address - Phone:724-603-6200
Practice Address - Fax:724-626-4480
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104032417Medicaid