Healthcare Provider Details

I. General information

NPI: 1154321230
Provider Name (Legal Business Name): PATRICIA M GRADY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MIDWAY DR STE 3
HARRINGTON DE
19952
US

IV. Provider business mailing address

1000 MIDWAY DR STE 3
HARRINGTON DE
19952-2448
US

V. Phone/Fax

Practice location:
  • Phone: 800-818-8680
  • Fax: 800-818-8680
Mailing address:
  • Phone: 800-818-8680
  • Fax: 800-818-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR125335
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: