Provider Demographics
NPI:1700334430
Name:EWELIKE, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:EWELIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:EWELIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN/LVN
Mailing Address - Street 1:9729 SPRINGTREE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5703
Mailing Address - Country:US
Mailing Address - Phone:972-310-6070
Mailing Address - Fax:214-484-9534
Practice Address - Street 1:10925 ESTATE LN
Practice Address - Street 2:SUITE 240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2315
Practice Address - Country:US
Practice Address - Phone:972-310-6070
Practice Address - Fax:214-484-9534
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332643164X00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider