Provider Demographics
NPI:1871872481
Name:GRADY, ALISON (RN)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12151 ELM FOREST CT
Mailing Address - Street 2:UNIT L
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-6306
Mailing Address - Country:US
Mailing Address - Phone:516-509-2762
Mailing Address - Fax:
Practice Address - Street 1:12151 ELM FOREST CT
Practice Address - Street 2:UNIT L
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-6306
Practice Address - Country:US
Practice Address - Phone:516-509-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT20110861163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse