MEDICARE: JANET MICHELLE GRADLE CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APO241	AZ

General Provider Information

NPI Number	:	1710042957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MICHELLE GRADLE CPNP

Provider Business Mailing Address
First Line	:	2502 N CABOT
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-1516
Country	:	US
Telephone Number	:	480-889-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 206
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-6496
Country	:	US
Telephone Number	:	480-889-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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