| Provider / Organization | NPI | Date Certified |
|---|---|---|
| GRACE E. WANDERSLEBEN | 1376142844 | 2020-10-25 |
Grace E Wandersleben [F] graduated in 2013 and primarily specializes in General Practice.
Grace E. Wandersleben is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1376142844. Registration indicates Grace E. Wandersleben is a provider of access to adult/geriatric primary care providers services with a specialization in Allopathic & Osteopathic Physicians, General Practice Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, General Practice) (Allopathic & Osteopathic Physicians, General Practice) (General Practice, ) (Primary Care/Family Planning/APRN/PA, ) (General Practice, Allopathic & Osteopathic Physicians)
| PECOS ID | 4486068947 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Grace E. Wandersleben MD |
| Practice Office Address | CARRETERA 188 KM 1.5 BARRIO SAN ISIDRO CANOVANAS, PR US |
| Practice Office Telephone | 7879572020 |
| Mailing Address | PO BOX 155 RIO GRANDE, PR 007450155 US |
| Business Telephone | 7872406585 |
| Code | Practice | License No State |
|---|---|---|
| 208D00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians General PracticeAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians General Practice Allopathic & Osteopathic Physicians General Practice General Practice Primary Care/Family Planning/APRN/PA General Practice Allopathic & Osteopathic Physicians | 022070
PR |