Provider Demographics
NPI:1578152203
Name:KINGORI, GRACE WANJIKU
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:WANJIKU
Last Name:KINGORI
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 1:6903 BRIGHTWAY PL APT J
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5786
Mailing Address - Country:US
Mailing Address - Phone:443-985-0626
Mailing Address - Fax:
Practice Address - Street 1:6903 BRIGHTWAY PL APT J
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5786
Practice Address - Country:US
Practice Address - Phone:443-985-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194128163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice