Provider Demographics
NPI:1922176015
Name:POWERS, GRACE MARIE ROSALES (RN)
Entity Type:Individual
Prefix:
First Name:GRACE MARIE
Middle Name:ROSALES
Last Name:POWERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4611
Mailing Address - Country:US
Mailing Address - Phone:503-235-5058
Mailing Address - Fax:
Practice Address - Street 1:8507 NE 8TH WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1980
Practice Address - Country:US
Practice Address - Phone:360-254-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00161724163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical