Provider Demographics
NPI:1770835456
Name:SPLETZER, GRACE (CNIM)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SPLETZER
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SHADOW VIEW DR
Mailing Address - Street 2:#330
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4641
Mailing Address - Country:US
Mailing Address - Phone:330-984-9205
Mailing Address - Fax:
Practice Address - Street 1:812 AVIS DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9649
Practice Address - Country:US
Practice Address - Phone:734-213-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2196246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other