Provider Demographics
NPI:1346907060
Name:THE GRACE CENTER FOR WOMEN'S HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:THE GRACE CENTER FOR WOMEN'S HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOMEN'S HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:TREGRE
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP-BC
Authorized Official - Phone:251-643-4293
Mailing Address - Street 1:1527 GAUSE BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2244
Mailing Address - Country:US
Mailing Address - Phone:251-643-4293
Mailing Address - Fax:
Practice Address - Street 1:9954 LAKE FOREST BLVD STE 10
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2647
Practice Address - Country:US
Practice Address - Phone:504-241-0105
Practice Address - Fax:504-241-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty