Provider Demographics
NPI:1790032902
Name:WLASOWICZ, GRACE KATHERINE (RN, PHD, NPP)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:KATHERINE
Last Name:WLASOWICZ
Suffix:
Gender:F
Credentials:RN, PHD, NPP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:KATHERINE
Other - Last Name:SAIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHD, NPP
Mailing Address - Street 1:100 LINDEN OAKS, SUITE 200
Mailing Address - Street 2:LINDEN OAKS THERAPY OFFICE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-586-1600
Mailing Address - Fax:585-586-7951
Practice Address - Street 1:100 LINDEN OAKS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-586-1600
Practice Address - Fax:585-586-7951
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner