Provider Demographics
NPI:1144201864
Name:MILLION, GRACIE MAY (RN)
Entity Type:Individual
Prefix:MS
First Name:GRACIE
Middle Name:MAY
Last Name:MILLION
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8017 FOREST ASH
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4381
Mailing Address - Country:US
Mailing Address - Phone:210-916-2252
Mailing Address - Fax:210-916-3585
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:BLDG 3600 BROOKE ARMY MEDICAL CENTER
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-2252
Practice Address - Fax:210-916-3585
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589531163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis