MEDICARE: MRS. DORSEY GRADIS ANP

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	207Q00000X	Family Medicine Physician	AG10250062	AZ

General Provider Information

NPI Number	:	1982568911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORSEY GRADIS ANP

Provider Business Mailing Address
First Line	:	24815 S ELLSWORTH RD APT 196
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1929
Country	:	US
Telephone Number	:	520-661-5293
Fax Number	:

Provider Business Practice Location Address
First Line	:	24815 S ELLSWORTH RD APT 196
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1929
Country	:	US
Telephone Number	:	520-661-5293
Fax Number	:

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

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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