Most Relevant Information
Provider Data
| NPI Number: | 1003584194 |
| Provider Name: | GRACE A NIMOH |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 0002099391 |
Most Important Dates
| Enumeration Date: | 09/02/2021 |
| Last Updated: | 09/02/2021 |
Provider Practice Location
8427 DORSEY CIR
MANASSAS
VA
201104596
Practice Location Phone/Fax
| Phone: | 7033307517 |
| Fax: | 7036564893 |
Provider Mailing Location
8427 DORSEY CIR
MANASSAS
VA
201104596
Provider Mailing Phone/Fax
| Phone: | 7033307517 |
| Fax: | 7036564893 |