Provider Demographics
NPI:1245055474
Name:LISTON, GRACE JOAN
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:JOAN
Last Name:LISTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 FINDLAY ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3446
Mailing Address - Country:US
Mailing Address - Phone:419-707-2553
Mailing Address - Fax:
Practice Address - Street 1:623 FINDLAY ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3446
Practice Address - Country:US
Practice Address - Phone:419-707-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health