Provider Demographics
NPI:1053432708
Name:GRICE, LAURA M (ND)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:GRICE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7847 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9324
Mailing Address - Country:US
Mailing Address - Phone:815-464-6396
Mailing Address - Fax:
Practice Address - Street 1:7847 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9324
Practice Address - Country:US
Practice Address - Phone:815-464-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009925425OtherBLUE CROSS BLUE SHIELD