Provider Demographics
NPI:1356879456
Name:TRAN, GRACE (NP-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 LARKIN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5827
Mailing Address - Country:US
Mailing Address - Phone:847-289-5727
Mailing Address - Fax:847-888-5469
Practice Address - Street 1:1990 LARKIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5827
Practice Address - Country:US
Practice Address - Phone:847-289-5727
Practice Address - Fax:847-888-5469
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016004363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209016004Medicaid
ILMT4586927OtherDEA