Provider Demographics
NPI:1275033052
Name:VILLARREAL THOMPSON, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:VILLARREAL THOMPSON
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 1:123 GALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-6045
Mailing Address - Country:US
Mailing Address - Phone:469-464-6547
Mailing Address - Fax:
Practice Address - Street 1:123 GALLEY DR
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-6045
Practice Address - Country:US
Practice Address - Phone:469-464-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333778164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse