Provider Demographics
NPI:1235449414
Name:BLAND, GRACE VANESSA
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:VANESSA
Last Name:BLAND
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 1:5223 GLENDORA CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5346
Mailing Address - Country:US
Mailing Address - Phone:619-817-6488
Mailing Address - Fax:
Practice Address - Street 1:5223 GLENDORA CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5346
Practice Address - Country:US
Practice Address - Phone:619-817-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 188675372500000X, 376K00000X
GARH 188675372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion