Provider Demographics
NPI:1881137776
Name:NORTON, GRACE (RDN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:NORTON
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9393 E PALO BREA BND APT 1097
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6510
Mailing Address - Country:US
Mailing Address - Phone:480-416-7295
Mailing Address - Fax:
Practice Address - Street 1:4408 N 38TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4114
Practice Address - Country:US
Practice Address - Phone:480-256-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-61999174N00000X
AZ1049578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN