Provider Demographics
NPI:1922730019
Name:MILLS, GRACE ANNA ROSE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNA ROSE
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANNA ROSE
Other - Last Name:WALDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PL MSC 8116-0043-14
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2094
Mailing Address - Fax:314-454-2515
Practice Address - Street 1:1 CHILDRENS PL MSC 8116-0043-14
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2094
Practice Address - Fax:314-454-2515
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024016629208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics