Provider Demographics
NPI:1912782491
Name:NTUBE, GRACE ABWENZOH (RN)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ABWENZOH
Last Name:NTUBE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 SW LYNMAR PL
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-8697
Mailing Address - Country:US
Mailing Address - Phone:832-240-3242
Mailing Address - Fax:
Practice Address - Street 1:6111 SW LYNMAR PL
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-8697
Practice Address - Country:US
Practice Address - Phone:832-240-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202103694RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse