Provider Demographics
NPI:1578176970
Name:GILMORE, GRACE PULLIAM (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:PULLIAM
Last Name:GILMORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MALVERN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2666
Mailing Address - Country:US
Mailing Address - Phone:540-229-2268
Mailing Address - Fax:
Practice Address - Street 1:29 MALVERN AVE APT 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2666
Practice Address - Country:US
Practice Address - Phone:540-229-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily