Provider Demographics
NPI:1053667154
Name:AMAKULOR, GRACE OLUCHI (LPN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:OLUCHI
Last Name:AMAKULOR
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 1:2555 JOHN STEVEN WAY
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5249
Mailing Address - Country:US
Mailing Address - Phone:614-270-4877
Mailing Address - Fax:
Practice Address - Street 1:2555 JOHN STEVEN WAY
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5249
Practice Address - Country:US
Practice Address - Phone:614-270-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN149123-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse