Provider Demographics
NPI:1235526716
Name:EDWARDS, GRACE ELAINE
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:ELAINE
Last Name:EDWARDS
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 1:1125 OLD HUNTER RUN
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-1494
Mailing Address - Country:US
Mailing Address - Phone:815-218-3979
Mailing Address - Fax:
Practice Address - Street 1:1125 OLD HUNTER RUN
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1494
Practice Address - Country:US
Practice Address - Phone:815-218-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer