Provider Demographics
NPI:1386323665
Name:GRADY, LESLEY ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANNE
Last Name:GRADY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TUSCARAWAS ST W STE 440
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4698
Mailing Address - Country:US
Mailing Address - Phone:330-453-4000
Mailing Address - Fax:
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 440
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4698
Practice Address - Country:US
Practice Address - Phone:330-453-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034036363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care