Provider Demographics
NPI:1013325158
Name:OSTAN, GRACE CATHERINE (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CATHERINE
Last Name:OSTAN
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:704-384-1550
Mailing Address - Fax:
Practice Address - Street 1:1730 E WOODLAWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2234
Practice Address - Country:US
Practice Address - Phone:704-384-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007056363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013325158Medicaid
NCNCN078AMedicare UPIN