Provider Demographics
NPI:1679761761
Name:TODD, GRACE IHSIU (RN, CRNP-ADULT)
Entity Type:Individual
Prefix:
First Name:GRACE IHSIU
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:RN, CRNP-ADULT
Other - Prefix:
Other - First Name:GRACE IHSIU
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:964 MEZZANINE DR
Mailing Address - Street 2:PLANNED PARENTHOOD OF INDIANA AND KENTUCKY
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8631
Mailing Address - Country:US
Mailing Address - Phone:765-446-8078
Mailing Address - Fax:765-446-8160
Practice Address - Street 1:964 MEZZANINE DR
Practice Address - Street 2:PLANNED PARENTHOOD OF INDIANA AND KENTUCKY
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8631
Practice Address - Country:US
Practice Address - Phone:765-446-8078
Practice Address - Fax:765-446-8160
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28180419A363LA2200X
TX841764363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health