Provider Demographics
NPI:1801452172
Name:MCCORMICK, GRACE TRINIDAD (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:TRINIDAD
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:GONZALES
Other - Last Name:TRINIDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2302 KEEGAN HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3325
Mailing Address - Country:US
Mailing Address - Phone:281-904-5933
Mailing Address - Fax:
Practice Address - Street 1:602 W SEMANDS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1867
Practice Address - Country:US
Practice Address - Phone:936-756-5598
Practice Address - Fax:936-756-5974
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse