Provider Demographics
NPI:1073867347
Name:DOOLITTLE, GRACE MARIA (RNC, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MARIA
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:NICU 4TH FLOOR EAST BUILDING
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-7624
Mailing Address - Fax:612-273-7625
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:NICU 4TH FLOOR EAST BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-7624
Practice Address - Fax:612-273-7625
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR935337163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant