| Mercy Grace Private Practice | |
|
1720 E Boston St Gilbert AZ 85295-6226 | |
| (480) 745-3702 | |
| (480) 745-3709 |
| Full Name | Mercy Grace Private Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1720 E Boston St, Gilbert, Arizona |
| Authorized Official Name and Position | Michelle Reyes (OFFICE MANAGER) |
| Authorized Official Contact | 4807453704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Grace Private Practice 1720 E Boston St Gilbert AZ 85295-6226 Ph: (480) 745-3702 | Mercy Grace Private Practice 1720 E Boston St Gilbert AZ 85295-6226 Ph: (480) 745-3702 |
| NPI Number | 1225462468 |
|---|---|
| Provider Enumeration Date | 08/23/2013 |
| Last Update Date | 07/17/2024 |
| Medicare PECOS PAC ID | 4789807280 |
|---|---|
| Medicare Enrollment ID | O20140602002451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225462468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 40145 (Arizona) | Primary |
| Provider Name | Hope M Ijaola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518120500 PECOS PAC ID: 3375619950 Enrollment ID: I20080904000681 |
| Provider Name | Nancy Cecile Erdmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194848002 PECOS PAC ID: 7618102435 Enrollment ID: I20131104000906 |
| Provider Name | Candice Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447884846 PECOS PAC ID: 3971929787 Enrollment ID: I20200811002321 |
| Provider Name | Farheen I Khan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497369219 PECOS PAC ID: 0648687533 Enrollment ID: I20210319001398 |
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