Grace Edith Line

Primary specialty

DriverTaxonomy code 172A00000X

License

L500-3056-2668-05 Issued in WI

Practice address

4125 E Itasca St
Superior, WI 54880-4239

Phone

(218) 481-5357

NPI assigned

Feb 13, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1790318186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4125 E ITASCA ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804239",
            "telephone_number": "218-481-5357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 E ITASCA ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804239",
            "telephone_number": "218-481-5357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINE",
        "first_name": "GRACE",
        "middle_name": "EDITH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-13",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "WI",
            "license": "L500-3056-2668-05",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Driver in Superior, WI
• Providers in Superior, WI by specialty
• Driver in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.