Provider Demographics
NPI:1356138309
Name:MERTZ, GRACE NICOLE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:NICOLE
Last Name:MERTZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 UNIVERSITY AVE
Mailing Address - Street 2:APT 332
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726
Mailing Address - Country:US
Mailing Address - Phone:715-701-6009
Mailing Address - Fax:
Practice Address - Street 1:621 SCIENCE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1074
Practice Address - Country:US
Practice Address - Phone:476-560-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program