Provider Demographics
NPI:1164094785
Name:SMALLS, GRACE ANGELA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANGELA
Last Name:SMALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 EMERSON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4518
Mailing Address - Country:US
Mailing Address - Phone:202-428-5604
Mailing Address - Fax:
Practice Address - Street 1:800 EMERSON ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4518
Practice Address - Country:US
Practice Address - Phone:202-722-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide