Provider Demographics
NPI:1639543937
Name:ROXAS, GRACE MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:GRACE MARIE
Middle Name:
Last Name:ROXAS
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1805
Mailing Address - Country:US
Mailing Address - Phone:847-304-0781
Mailing Address - Fax:833-464-5450
Practice Address - Street 1:100 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1805
Practice Address - Country:US
Practice Address - Phone:847-304-0781
Practice Address - Fax:833-464-5450
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013581363LF0000X
IL277001341363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily