Provider Demographics
NPI:1306000500
Name:EKUKOLE-SONE, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:EKUKOLE-SONE
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 1:8208 REYNOLDSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9333
Mailing Address - Country:US
Mailing Address - Phone:614-314-5416
Mailing Address - Fax:
Practice Address - Street 1:8208 REYNOLDSWOOD DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9333
Practice Address - Country:US
Practice Address - Phone:614-314-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN299776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2609921Medicaid