Provider Demographics
NPI:1861299315
Name:WAINWRIGHT, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WAINWRIGHT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 KENDALL LN
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2567
Mailing Address - Country:US
Mailing Address - Phone:715-531-5001
Mailing Address - Fax:
Practice Address - Street 1:519 KENDALL LN
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2567
Practice Address - Country:US
Practice Address - Phone:715-531-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041549379163W00000X
IL1486376374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse