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General NPI Number Information
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NPI Number | 1477016897
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Entity Type | Individual
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Provider Name | LAUREN GENELLE GRADO CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 8280 W WARM SPRINGS RD
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City | LAS VEGAS
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State | NV
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Zip | 89113-3612
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Country | US
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Telephone | 702-707-9821
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Fax |
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Provider Business Mailing Address
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Address Line | 11887 OAKLAND HILLS DR
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City | LAS VEGAS
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State | NV
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Zip | 89141-6014
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Country | US
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Telephone | 530-391-1465
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 819290
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License Number State | NV
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