Provider Demographics
NPI:1164864518
Name:YUDOM, GRACE E (LPN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:E
Last Name:YUDOM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JEFFERSON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6628
Mailing Address - Country:US
Mailing Address - Phone:202-640-8197
Mailing Address - Fax:202-635-5780
Practice Address - Street 1:1100 NEW JERSEY AVE SE STE 845
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3338
Practice Address - Country:US
Practice Address - Phone:866-617-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005854164W00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide