Provider Demographics
NPI:1700395787
Name:SCHUMACHER, GRACE ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELIZABETH
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S. COLONY WAY
Mailing Address - Street 2:STE 3, PMB 269
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6972
Mailing Address - Country:US
Mailing Address - Phone:907-631-9005
Mailing Address - Fax:
Practice Address - Street 1:10355 E PALMER WASILLA HWY # 120-A
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8876
Practice Address - Country:US
Practice Address - Phone:469-275-4507
Practice Address - Fax:469-278-6762
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK105564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered