Provider Demographics
NPI:1760856157
Name:KLEIN, GRACE (RN, PHD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CHICKADONZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHD
Mailing Address - Street 1:15 ARNOLD PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2001
Mailing Address - Country:US
Mailing Address - Phone:585-473-2733
Mailing Address - Fax:585-473-5472
Practice Address - Street 1:15 ARNOLD PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2001
Practice Address - Country:US
Practice Address - Phone:585-473-2733
Practice Address - Fax:585-473-5472
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY373483-1163W00000X
NYNY373483163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse