Provider Demographics
NPI:1386384592
Name:STAMMEN, GRACE ELLEN (DO)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLEN
Last Name:STAMMEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374MDG
Mailing Address - Street 2:UNIT 5071, APO AP
Mailing Address - City:TOKYO
Mailing Address - State:KANTO PLAIN
Mailing Address - Zip Code:96328
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:374MDG
Practice Address - Street 2:UNIT 5071, APO AP
Practice Address - City:TOKYO
Practice Address - State:KANTO PLAIN
Practice Address - Zip Code:96328
Practice Address - Country:JP
Practice Address - Phone:419-852-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH1386384592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program