Provider Demographics
NPI:1770254666
Name:MADUEKE, GRACE AMALACHUKWU
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:AMALACHUKWU
Last Name:MADUEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N ATLANTIC ST STE 4700
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2318
Mailing Address - Country:US
Mailing Address - Phone:509-934-4070
Mailing Address - Fax:
Practice Address - Street 1:1313 N ATLANTIC ST STE 4700
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2318
Practice Address - Country:US
Practice Address - Phone:509-934-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61508543363LP0808X
IN28243400A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health