Gracey Mae Eden
Student in an Organized Health Care Education/Training Program in Bangor, PA. Individual provider (NPI-1).
NPI number1639634785
StatusActive
Last updated in NPPESFeb 4, 2019
Details
- NPI
- 1639634785
- Entity type
- Individual (NPI-1)
- Name
- Gracey Mae Eden
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 4, 2019
- Last updated
- Feb 4, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
712 Laurel Hill RdBangor, PA 18013-5564
Phone 520-343-8221
Mailing address
712 Laurel Hill RdBangor, PA 18013-5564
Phone 520-343-8221
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