Provider Demographics
NPI:1710136395
Name:SONG, GRACE (PA)
Entity Type:Individual
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First Name:GRACE
Middle Name:
Last Name:SONG
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Gender:F
Credentials:PA
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Mailing Address - Street 1:401 CASTLE CREEK RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1159
Mailing Address - Country:US
Mailing Address - Phone:970-925-4141
Mailing Address - Fax:970-927-8633
Practice Address - Street 1:1450 E VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8304
Practice Address - Country:US
Practice Address - Phone:970-927-8611
Practice Address - Fax:970-927-8633
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2013-10-04
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant