Basic Information
| Provider Information | |||||||||
| NPI: | 1215645825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIAN | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | RAKAUSKAS | ||||||||
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| Credential: | CD(DONA) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1142 HOWBERT AVE SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240151716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198304165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1906 BELLEVIEW AVE SE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409817000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2022 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374J00000X | 14691 | Y | Nursing Service Related Providers | Doula |
No ID Information.