Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2014035054 | MO |
NPI | 1003487224 |
---|---|
Provider Name | Grace Louise Colson |
First Address | Grand Rapids, MI 49506-3504 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 02/11/2021 |