Basic Information
| Provider Information | |||||||||
| NPI: | 1710042957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRADLE | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2502 N CABOT | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852071516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808891234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1075 S IDAHO RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | APACHE JUNCTION | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852196496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808891234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LP0200X | APO241 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.