Provider Demographics
NPI:1609672070
Name:ANDERSON, GRACE R (CNCS, HHP, MCD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:
Credentials:CNCS, HHP, MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-9013
Mailing Address - Country:US
Mailing Address - Phone:906-251-8195
Mailing Address - Fax:
Practice Address - Street 1:1935 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-9013
Practice Address - Country:US
Practice Address - Phone:906-251-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7214-14374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula