Basic Information
| Provider Information | |||||||||
| NPI: | 1457808206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH-GRADY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | FRANCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24439 ROSS ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135051475 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26650 EUREKA RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481804835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349414991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704248955 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.