Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | ARNP9216526 | FL |
NPI | 1013180835 |
---|---|
Provider Name | Kathleen Susan Grady-Greene |
First Address | Gainesville, FL 32605-2075 |
Second Address | Austin, TX 78705-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2008 |
Last Update Date | 18/06/2020 |