Provider Demographics
NPI:1952846925
Name:WIREDU, GRACE (CNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WIREDU
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2440
Mailing Address - Country:US
Mailing Address - Phone:614-235-5555
Mailing Address - Fax:614-536-1994
Practice Address - Street 1:5000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2440
Practice Address - Country:US
Practice Address - Phone:614-235-5555
Practice Address - Fax:614-536-1994
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily