Provider Demographics
NPI:1356071666
Name:GRACE, LINDA ANNE (RN, BS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:GRACE
Suffix:
Gender:F
Credentials:RN, BS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7876 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-7201
Mailing Address - Country:US
Mailing Address - Phone:714-681-3999
Mailing Address - Fax:714-755-3648
Practice Address - Street 1:10507 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1128
Practice Address - Country:US
Practice Address - Phone:714-689-2300
Practice Address - Fax:714-689-2301
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA328667163WA2000X, 163WH0200X, 163WH1000X, 163WI0500X, 163WP0807X, 163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult