Provider Demographics
NPI:1184315533
Name:RODLAUER, GRACE C (NP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:RODLAUER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 CRIMSON CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-1818
Mailing Address - Country:US
Mailing Address - Phone:858-761-7654
Mailing Address - Fax:
Practice Address - Street 1:1242 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3238
Practice Address - Country:US
Practice Address - Phone:202-978-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070333163W00000X, 363L00000X
VA0001290442163W00000X
MDR237365163W00000X, 363L00000X
DCRN1044642163W00000X
CA95216791163W00000X
VA0024183778363L00000X
CA95015707363L00000X
DCNP1044642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse