Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN157187 | GA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN157187 | GA |
N | 363LA2200X | Nurse Practitioner - Adult Health | RN157187 | GA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN157187 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN157187 | GA |
NPI | 1407342603 |
---|---|
Provider Name | Mrs. Mary Grace B Nuega |
First Address | Atlanta, GA 30341-1071 |
Second Address | Fayetteville, GA 30214-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 03/01/2020 |