Provider Demographics
NPI:1457851628
Name:GRACE, SONIA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 RAYMON DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2738
Mailing Address - Country:US
Mailing Address - Phone:470-734-4518
Mailing Address - Fax:
Practice Address - Street 1:675 JUSTICE WAY ROOM C0049
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203
Practice Address - Country:US
Practice Address - Phone:877-465-6650
Practice Address - Fax:804-294-2775
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28130736A163W00000X
IN28130636A163WA0400X
IN71007804B363L00000X
IN71007804A363LG0600X
VA0024193179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology