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General NPI Number Information
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NPI Number | 1710042957
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Entity Type | Individual
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Provider Name | JANET MICHELLE GRADLE CPNP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1075 S IDAHO RD SUITE 206
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City | APACHE JUNCTION
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State | AZ
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Zip | 85219-6496
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Country | US
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Telephone | 480-889-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 2502 N CABOT
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City | MESA
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State | AZ
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Zip | 85207-1516
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Country | US
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Telephone | 480-889-1234
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APO241
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License Number State | AZ
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