Provider Demographics
NPI:1922056316
Name:FAULKNER, GRACE PATRICIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:PATRICIA
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11136 ELDER RD
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-8089
Mailing Address - Country:US
Mailing Address - Phone:608-372-6908
Mailing Address - Fax:
Practice Address - Street 1:11136 ELDER RD
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-8089
Practice Address - Country:US
Practice Address - Phone:608-372-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI102272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse