Provider Demographics
NPI:1598202079
Name:NTEFF, GRACE MISI (FNP)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MISI
Last Name:NTEFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MISI
Other - Middle Name:GRACE
Other - Last Name:NTEFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 CLAYTON STATE BLVD
Mailing Address - Street 2:CLAYTON STATE UNIVERSITY, SCHOOL OF NURSING
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260
Mailing Address - Country:US
Mailing Address - Phone:678-466-5551
Mailing Address - Fax:678-466-4999
Practice Address - Street 1:1000 CLAYTON VILLAGE
Practice Address - Street 2:CLAYTON STATE UNIVERSITY, SCHOOL OF NURSING COMMUNITY
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260
Practice Address - Country:US
Practice Address - Phone:678-466-5590
Practice Address - Fax:678-466-4999
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN065496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily