Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 48399914405 | UT |
NPI | 1043274863 |
---|---|
Provider Name | Carole Ann Grady |
First Address | St George, UT 84790-1567 |
Second Address | St George, UT 84770-3583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/07/2007 |