Healthcare Provider Details

I. General information

NPI: 1124946991
Provider Name (Legal Business Name): KAJANJAN CONSTANCE GRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WARRIOR CIRCLE RD
MANDAREE ND
58757-9212
US

IV. Provider business mailing address

3315 UNIVERSITY DR
BISMARCK ND
58504-7554
US

V. Phone/Fax

Practice location:
  • Phone: 701-421-0145
  • Fax:
Mailing address:
  • Phone: 701-421-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: