Provider Demographics
NPI:1124402649
Name:GRACE, JULIE D (DN)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:D
Last Name:GRACE
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22383
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-2383
Mailing Address - Country:US
Mailing Address - Phone:505-231-6158
Mailing Address - Fax:505-216-1119
Practice Address - Street 1:1807 2ND ST
Practice Address - Street 2:SUITE 44C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3499
Practice Address - Country:US
Practice Address - Phone:505-216-1119
Practice Address - Fax:505-349-4748
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01015172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath