| Gracefilled LLC | |
|
805 Baggins Ct Gallatin TN 37066-0016 | |
| (732) 423-4057 | |
| Not Available |
| Full Name | Gracefilled LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 805 Baggins Ct, Gallatin, Tennessee |
| Authorized Official Name and Position | Maryjane Henshaw (OWNER) |
| Authorized Official Contact | 6156025375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gracefilled LLC 805 Baggins Ct Gallatin TN 37066-0016 | Gracefilled LLC 805 Baggins Ct Gallatin TN 37066-0016 Ph: (732) 423-4057 |
| NPI Number | 1043191760 |
|---|---|
| Provider Enumeration Date | 09/09/2025 |
| Last Update Date | 09/09/2025 |
| Certification Date | 09/09/2025 |
| Medicare PECOS PAC ID | 7810493772 |
|---|---|
| Medicare Enrollment ID | O20251001000070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043191760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Maryjane Chinyere Henshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124853320 PECOS PAC ID: 8729584685 Enrollment ID: I20251001000152 |
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