Provider Demographics
NPI:1174026249
Name:UWAGBAI, GRACE A (LVN)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:A
Last Name:UWAGBAI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 SOMERTON DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8590
Mailing Address - Country:US
Mailing Address - Phone:817-983-9986
Mailing Address - Fax:
Practice Address - Street 1:5828 SOMERTON DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8590
Practice Address - Country:US
Practice Address - Phone:817-983-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208133164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse