Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 11009479 | FL |
NPI | 1114525789 |
---|---|
Provider Name | Grace Patricia Dible |
First Address | Indianapolis, IN 46203-1932 |
Second Address | San Mateo, CA 94404-1560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2020 |
Last Update Date | 14/04/2021 |