Provider Demographics
NPI:1033472733
Name:MAOSA, GRACE (LPN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MAOSA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 CARINTHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1208
Mailing Address - Country:US
Mailing Address - Phone:937-304-9636
Mailing Address - Fax:
Practice Address - Street 1:6600 CARINTHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-1208
Practice Address - Country:US
Practice Address - Phone:937-304-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN122457164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse