Provider Demographics
NPI:1760902050
Name:GRACE, TAYLOR (LPN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608
Mailing Address - Country:US
Mailing Address - Phone:404-449-9475
Mailing Address - Fax:
Practice Address - Street 1:115 E OAKLAND
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:404-449-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:2019-12-03
Deactivation Code:
Reactivation Date:2020-02-26
Provider Licenses
StateLicense IDTaxonomies
OHLPN.173362.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse