Provider Demographics
NPI:1164121208
Name:MCINTYRE, GRACE (AGNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 EDWARDS MILL RD STE 112-398
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4275
Mailing Address - Country:US
Mailing Address - Phone:919-878-1819
Mailing Address - Fax:
Practice Address - Street 1:3434 EDWARDS MILL RD STE 112-398
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4275
Practice Address - Country:US
Practice Address - Phone:919-878-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017746363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health