Provider Demographics
NPI:1174387971
Name:BACKED BY GRACE PLLC
Entity type:Organization
Organization Name:BACKED BY GRACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MISS/NURSE PRACITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARVISE
Authorized Official - Middle Name:IJEOMA
Authorized Official - Last Name:ODUAGU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-597-4465
Mailing Address - Street 1:2451 KLAMATH DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6789
Mailing Address - Country:US
Mailing Address - Phone:214-597-4465
Mailing Address - Fax:
Practice Address - Street 1:2451 KLAMATH DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-6789
Practice Address - Country:US
Practice Address - Phone:214-597-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health