Healthcare Provider Details

I. General information

NPI: 1568737989
Provider Name (Legal Business Name): NICOLE MONIQUE MCDADE-GRAYSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 GUNTHER AVE
BRONX NY
10469-6105
US

IV. Provider business mailing address

2545 GUNTHER AVE
BRONX NY
10469-6105
US

V. Phone/Fax

Practice location:
  • Phone: 718-320-8749
  • Fax: 718-320-7135
Mailing address:
  • Phone: 718-320-8749
  • Fax: 718-320-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number446018-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: