Provider Demographics
NPI:1811656820
Name:GRACE MEDICAL LLC
Entity type:Organization
Organization Name:GRACE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKSHIRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOSELY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:504-376-4017
Mailing Address - Street 1:5444 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4222
Mailing Address - Country:US
Mailing Address - Phone:504-376-4017
Mailing Address - Fax:
Practice Address - Street 1:5444 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-539-8364
Practice Address - Fax:803-753-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty