Healthcare Provider Details

I. General information

NPI: 1538563853
Provider Name (Legal Business Name): ROCHELLE GRADY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 S 107TH AVE STE 205
OMAHA NE
68127-1965
US

IV. Provider business mailing address

2709 BEALE CIR
BELLEVUE NE
68123-1712
US

V. Phone/Fax

Practice location:
  • Phone: 402-597-2585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number77642
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: