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General NPI Number Information
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NPI Number | 1396954574
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Entity Type | Individual
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Provider Name | ELIZABETH KATHLEEN GRADY NMD DOCTOR OF NATURO
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 130 W RIVER RD BLDG A
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City | TUCSON
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State | AZ
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Zip | 85704
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Country | US
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Telephone | 520-877-2668
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Fax | 520-888-2004
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Provider Business Mailing Address
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Address Line | 9920 N HACIENDA HERMOSA DR
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City | ORO VALLEY
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State | AZ
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Zip | 85737
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Country | US
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Telephone | 520-878-0526
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Fax | 520-878-0526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00572
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License Number State | AZ
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