Healthcare Provider Details

I. General information

NPI: 1336178904
Provider Name (Legal Business Name): PAULA MARIE GRADY LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LINCOLN AVE
NAPA CA
94558-3610
US

IV. Provider business mailing address

2053 LONE OAK AVE
NAPA CA
94558-4620
US

V. Phone/Fax

Practice location:
  • Phone: 707-287-2822
  • Fax:
Mailing address:
  • Phone: 707-287-2822
  • Fax: 866-645-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: